Hidradenitis Suppurativa

Certain factors are associated with a higher likelihood of developing hidradenitis suppurativa:

• Women — HS is diagnosed more frequently in women, though it also affects men, often with different patterns of disease
• Onset after puberty, commonly in the 20s and 30s
• Smokers
• People who are overweight or obese
• People with a family history of HS
• People with related conditions, such as metabolic syndrome or Crohn's disease

‍

Treatment is tailored to severity and typically combines several approaches:

• Lifestyle measures — smoking cessation and weight management, both of which can meaningfully reduce disease severity
• Topical and oral antibiotics — used for their anti-inflammatory effect, not just to treat infection
• Hormonal treatments — such as the combined oral contraceptive pill or other anti-androgen therapies, particularly for women
• Biologic therapies — targeted injectable medications, such as adalimumab, which is subsidised on the PBS for moderate to severe HS that meets specific eligibility criteria, and other biologics used for more severe or resistant disease
• Procedural treatments — including laser hair removal in affected areas, and in-clinic procedures to drain or treat individual lesions
• Surgery — deroofing of sinus tracts or wider excision of affected skin, generally reserved for more established or Stage II to III disease

Because HS varies so much in severity and pattern, treatment plans are individualised and often adjusted over time.

‍

We recommend seeing a dermatologist if:

• You have recurring, painful lumps or abscesses in the underarms, groin, or other skin folds, particularly if they keep coming back in the same area
• You've been told you have recurrent boils, but treatment for infection hasn't resolved the problem
• You're noticing scarring, tunnelling under the skin, or lesions that are becoming more widespread
• HS is affecting your confidence, mental health, or daily activities
• You're a smoker or living with obesity and want guidance on how lifestyle changes may help alongside medical treatment
• You're interested in newer treatment options, including biologic therapies, and want to know whether you're a suitable candidate

‍

Dermatologists commonly describe HS severity using the Hurley staging system:

• Stage I — isolated abscesses without sinus tracts or significant scarring
• Stage II — recurrent abscesses with sinus tract formation and scarring, but with areas of normal skin between lesions
• Stage III — widespread, interconnected abscesses and sinus tracts across an entire affected area

Staging helps guide treatment decisions, and disease can progress between stages over time, particularly without treatment.

‍

Yes — HS is increasingly recognised as a systemic inflammatory condition with associations beyond the skin. It's linked to a higher risk of metabolic syndrome, obesity, and type 2 diabetes, and there's a well-established association with inflammatory bowel disease, particularly Crohn's disease. Given the visible, painful, and often hidden nature of HS, it also carries a significant impact on mental health, with higher rates of depression and anxiety reported in people living with the condition. Because of these associations, dermatologists managing HS often consider a person's broader health, not just the skin itself.