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What is Hidradenitis Suppurativa?

Firstly,  Hidradenitis Suppurativa (HS) is a skin disease that causes lesions to form on and under the skin. Lesions can take the form of painful nodules, boil-like lumps, abscess or cysts. When the lesions burst, they sometimes release pus with an unpleasant odour.

When the lesions heal, they can scar deep under the skin. As HS progresses, the scars form tunnels or sinus tracts that connect. Although HS can affect any part of the body, it mostly affects:
• Underarms
• Groin
• Under the breasts
• Perianal area
• Inner thighs
• Buttocks

The Hurley System

If you have had symptoms like these in the past six months, you should certainly consult your doctor. Your doctor will examine you to determine if you have HS. Unfortunately, there is no cure for HS. And it is a progressive disease. Therefore it may worsen over time.

HS is graded using the Hurley Stage system. There are three stages in the Hurley system. Stage 1 (mild), stage 2 (moderate) and stage 3 (severe).

HS Stages

hs stage 1

Stage 1- Mild Hidradenitis Suppurativa

The first signs of HS are single or multiple lesions. The disease usually starts in the teen years or early twenties. And while HS affects both men and women, it is more common in women.
During stage 1, lesions swell and burst. They heal but can reoccur in the same place. So, recurrence in one of the trademarks of HS.

Stage 1 HS is often misdiagnosed as an ingrown hair or skin infection. But early treatment is essential to stop the spread of the disease.


Stage 1 HS is treated with:
• anti-biotics, gels and creams
• A steroid injection for swelling
• Or small surgical procure called an incision and drainage (I&D).
Home remedies for stage 1 HS may also be helpful. These include essential oils, Epsom salts or a warm compress that certainly can relieve pain.

hidradenitis suppurativa stage 2

Stage 2- Moderate Hidradenitis Suppurativa

Stage 2 is characterised by tunnelling or sinus tract formation. Where old wounds have healed, scar tissue builds up and creates tunnels under the skin. New lesions can still form, so treatment focuses on preventing flare-ups. Thus, reducing scarring.

Your doctor may refer you to a dermatologist. And medications are available which your doctor can advise you on. Your doctor may also prescribe antibiotics for infections.

In addition to home remedies, some people find lifestyle changes helpful.

Some changes to make include:

• Wearing loose clothing.
• Losing weight if required.
• Maintaining a healthy weight.
• Dietary changes.
• Quit smoking.

If you have any questions or concerns, you should consult your doctor.

Hidradenitis Suppurativa Stage 3

Stage 3- Severe Hidradenitis Suppurativa

Stage 3 HS is characterised by widespread lesions and sinus tracts. At this stage, the disease has spread to many sites on the body. And there may be no healthy skin in affected areas. Because the wounds don’t have the space to heal, they remain open and leaking.

You doctor will examine you and take a sample of the pus to rule out other infections. And as with stage 1 and 2 infections, your doctor will prescribe antibiotics. However, in the advanced stage of HS, you may need surgery.

Firstly, surgery for HS is called excision. And there are three types.
1. Wide excision- removes affected tissue and the tissue around it.
2. Tissue sparing excision- removes only affected tissue.
3. Local excision- removes individual lesions.

An alternative to surgery is laser treatment. Laser treatment uses a hot beam of light to remove lesions. However, this may only be an option for people with stages 1 and 2 of the disease.

Both excision and laser treatment can certainly be very effective treatments. However results vary from person to person. And not everyone is a candidate for all treatments.
Also, the treatments mentioned may not be available in your country or region. Or they may not be suitable for you. Your treatment team can certainly advise you on your options and help you make the right decision for you.

Hidradenitis Suppurativa can have an emotional toll as well as physical. So, if you need extra support, there are vibrant HS communities online. You can join the HidraWear support group here.

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