At Advanced Dermatology & Cosmetic Institute, we see patients every day dealing with a wide range of skin concerns, from winter dryness and acne flare-ups to more complex conditions that impact daily life. One such condition that doesn’t get as much attention as it should is Hidradenitis Suppurativa, or HS. If you’ve been experiencing painful lumps or recurring abscesses in areas like your armpits, groin, or under your breasts, you might be wondering what’s going on—and you’re not alone. HS affects many people, often starting after puberty and most commonly before age 40 (though it can persist or begin later in life), and it’s more common in women. Let’s break it down in a way that’s easy to understand, so you can feel empowered to seek the care you need.

Understanding HS: What It Is and Why It Happens

Hidradenitis Suppurativa, also known as acne inversa, is a chronic inflammatory skin disease that targets hair follicles. It occurs when these follicles become blocked and eventually rupture, triggering a significant inflammatory immune response that leads to painful nodules, abscesses, and sometimes even tunnels under the skin or scarring. Unlike typical acne, HS tends to show up in sweat-prone areas where skin rubs together, such as the groin, buttocks, armpits, and breasts.

The exact cause isn’t fully known, but experts believe the sequence begins with follicular occlusion—when hair follicles become blocked and eventually rupture, causing inflammation. Factors like genetics, hormones, smoking, and being overweight can play a role, but it’s important to note that HS is not caused by poor hygiene—it’s a medical condition that needs professional attention. If it runs in your family or you’ve noticed symptoms worsening with certain triggers, that’s a clue it might be HS.

Recognizing the Symptoms: From Mild to Severe

HS can start subtly but often progresses if left untreated. Early signs include small, painful, pea-sized lumps that feel like deep boils and can last for weeks or months. As it advances, you might experience:

  • Red, inflamed bumps that break open and drain pus
  • Blackheads or cysts in clusters
  • Itching, burning, or stinging before a flare-up
  • Scarring or skin tunnels (called sinus tracts) that connect lumps
  • A strong odor from drainage, which can add to the emotional toll

These symptoms can range from mild (a few isolated lumps) to severe (widespread scarring and constant pain), and they often recur in the same spots. HS is typically classified using Hurley staging:

  • Stage I: Abscesses without tunnels or scarring
  • Stage II: Recurrent abscesses with tunnel formation and scarring
  • Stage III: Diffuse involvement with interconnected tunnels across entire area

Many of our patients tell us the discomfort affects their confidence, mobility, and even work life—it’s more than skin deep.

Treatment Options: Managing HS for Better Days Ahead

The good news? While there’s no cure for HS, effective management can reduce flares and improve your quality of life. At our clinics in Edina, Waconia, and Shakopee, we tailor treatments to your needs, starting with a thorough evaluation by our board-certified dermatologists.

  • Lifestyle Changes: Simple steps like quitting smoking, maintaining a healthy weight, and wearing loose clothing can help minimize irritation.
  • Topical Cleanser: CLn® BodyWash reduces pain, itching, odor, drainage and irritation, supporting sensitive skin and maintaining a healthy skin barrier. (two ways to use)
    1. Shower Cleansing: Massage and lather onto skin for 1-2 minutes. Rinse thoroughly.
    2. Dab Method: Apply a dime size ‘dab’ of product directly on a lesion when you feel it starting – no shower needed!
  • Medications: Antibiotics for infections, anti-inflammatory drugs, or biologics (targeted therapies) can calm the underlying inflammation. FDA-approved biologic options include adalimumab (TNF-α inhibitor), secukinumab (IL-17A inhibitor), and bimekizumab (dual IL-17A/F inhibitor), which target specific immune pathways involved in HS.
  • In-Office Procedures: For more stubborn cases, we offer options like deroofing (unroofing) of abscesses and tunnels, laser therapy (such as Nd:YAG or Alexandrite) to reduce hair follicles, or surgical removal of affected areas to prevent recurrence.

Combining home care with professional treatments often yields the best results—just like we recommend for winter acne or barrier repair in our other posts. If you’re in the Minneapolis area, our team is here to guide you through virtual or in-person appointments.

Don’t Suffer in Silence—We’re Here to Help

HS can be frustrating and isolating, but understanding it is the first step toward relief. If this sounds familiar, don’t wait for symptoms to worsen. Schedule a consultation with us today to discuss personalized options that fit your lifestyle. Remember, healthy skin starts with expert care—let’s get you glowing again!