What is Hidradenitis Suppurativa (HS)?

How It Develops

1. Hair follicle gets blocked (hyperkeratosis)
2. The follicle ruptures, releasing keratin, bacteria, and sebum into the skin
3. This triggers a painful immune/inflammatory response
4. Bacteria like S. aureus cause secondary infection
5. As it heals, a new lesion forms nearby — this cycle repeats

What You Might Notice

Hurley Staging (How Bad Is It?)

Who Gets It?

• More common in women, young adults (18–29), and people of African descent
• Strongly linked to obesity — friction worsens it
• Smoking is a major trigger
• Can run in families (genetic mutations in gamma-secretase genes)
• Associated with diabetes, metabolic syndrome, PCOS, and inflammatory bowel disease

What You Should Do

Preventive measures you can start now:

• Wash the area daily with chlorhexidine (antiseptic) wash or benzoyl peroxide wash
• Wear loose-fitting, breathable clothing to reduce friction
• Avoid shaving the armpit with a razor — use laser or clippers instead
• Lose weight if overweight — this significantly reduces flares
• Stop smoking if you smoke
• Avoid excessive heat and sweating when possible

Medical treatments (prescribed by a doctor):

• Topical clindamycin (antibiotic gel applied to the skin)
• Oral doxycycline or minocycline (antibiotic tablets)
• Intralesional steroid injections for early lesions (very effective at stopping a flare early)
• Clindamycin + rifampicin combination — extensively studied, quite effective
• Adalimumab (Humira) — a biologic injection, FDA-approved for moderate-severe HS
• Surgery for severe/refractory cases

⚠️ Incision and drainage alone is strongly discouraged — it does not cure HS and can worsen scarring.

Important Warning

• Permanent tunnel formation and scarring
• Severe lymphedema (swelling of the arm)
• Rare but serious: squamous cell skin cancer developing in long-standing lesions

• Significant scarring and skin thickening across the entire armpit
• Bridged/hypertrophic scars — the characteristic "rope-like" scar tissue running across the axilla
• Post-inflammatory hyperpigmentation (darkening of the skin)
• No active boil right now — this appears to be the between-flare appearance after repeated episodes

What the Scarring Tells Us

This is Hurley Stage II — Here's Why It Matters

What You Must Do Now

Urgent steps:

1. See a dermatologist as soon as possible — tell them about the recurrent painful boils and show them this photo
2. Ask about oral antibiotic combinations (clindamycin + rifampicin is the most studied — 300mg of each, twice daily)
3. Ask about adalimumab (Humira) — the only FDA-approved biologic injection for HS, very effective at this stage
4. Start chlorhexidine wash on the armpit daily right now (available at pharmacies without prescription)

Right now at home:

• Wear loose, soft cotton clothing — friction makes every flare worse
• Avoid shaving the armpit with a razor
• If you smoke, stopping smoking is one of the single most effective things you can do to reduce flares
• Keep the area dry — moisture worsens it

Important

⚠️ This is not a diagnosis — only a doctor examining you in person can diagnose you. But the picture is strongly suggestive of HS and you deserve proper medical evaluation.

What This Active Boil Means

What To Do RIGHT NOW for This Active Boil

Do ✅

• Warm compress — apply a clean warm (not hot) cloth to it for 10–15 minutes, 3–4 times a day. This helps reduce pain and may help it drain naturally
• Keep it clean — gently wash with chlorhexidine or antiseptic soap
• Take ibuprofen or paracetamol for the pain
• Loose clothing — avoid anything rubbing against it

Do NOT ❌

• Do not squeeze or pop it — this pushes infection deeper into the skin and worsens scarring
• Do not shave over or near it while it is active
• Do not apply toothpaste, oils, or home remedies directly on it

When to Go to a Doctor Urgently

The Bigger Picture

Complete Treatment for Hidradenitis Suppurativa

STEP 1 — Daily Self-Care (Start Today, No Prescription Needed)

STEP 2 — Treatments for Active/Painful Boils (Doctor Visit)

For a single active boil like yours right now:

• Intralesional steroid injection (triamcinolone injected directly into the boil) — fastest way to shrink a painful boil, often works within 48–72 hours
• Topical clindamycin gel — applied to the skin twice daily

For recurring flares (oral antibiotics):

⚠️ Do NOT take antibiotics without a prescription. Long-term unsupervised antibiotic use causes resistance.

STEP 3 — Moderate-Severe Disease (Specialist Treatments)

Biologic Injections (most effective for Stage II–III)

Hormonal therapy (for men)

• Finasteride — helps reduce androgen-driven flares in men

Other options

• Isotretinoin — works in mild-moderate disease, especially younger patients
• Cyclosporine — for severe refractory cases
• Short course oral prednisone — only to control acute severe flares

STEP 4 — Laser & Light Treatments

• Nd:YAG laser — proven in a randomised trial to significantly improve HS; best for hair-bearing areas
• Laser hair removal — reduces follicle-driven triggers; should be done in unaffected areas as prevention
• CO2 laser — destroys sinus tracts and lesions

STEP 5 — Surgery (For Your Stage of Scarring)

• Wide surgical excision — the most effective surgical option; the scarred and affected skin is completely removed
• The recurrence rate in the axilla (armpit) is low after wide excision — this is good news for your location
• Sinus tracts are marked with dye during surgery to ensure complete removal
• The wound is either closed or left to heal naturally

Your Action Plan (Based on Your Photo)

1. This week → See a dermatologist. Ask for an intralesional steroid injection in the active boil
2. Short term → Start clindamycin + rifampicin antibiotic combination
3. Medium term → Discuss adalimumab (Humira) biologic injections to prevent further flares
4. Long term → Once stable, discuss wide surgical excision of the scarred armpit tissue

What Actually Causes and Worsens HS

Why This Myth Exists

What You Should Focus On

1. ✅ Stop smoking (if you smoke)
2. ✅ Lose weight if overweight
3. ✅ Daily chlorhexidine wash
4. ✅ Wear loose clothing
5. ✅ See a dermatologist for proper treatment
6. ✅ Avoid razor shaving in the armpit