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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Partly. A doctor by video can diagnose it and start first-line treatment; drainage, specialist medicines and surgery are done in person.
- What it is: a long-term inflammatory skin condition, affecting about 1 in 100 people, that causes painful lumps, abscesses, tunnels under the skin and scarring; women get it about 3 times as often as men.
- Where: the armpits, groin and genitals, around the anus, under the breasts, and sometimes the inner thighs, waistband and neck.
- Not an infection: it is not caused by poor hygiene and it is not contagious; smoking and excess weight make it worse.
- Emergency: call 112 for spreading redness with a high temperature, shivering, or feeling very unwell or confused.
Spreading redness with a high temperature, shivering, or feeling very unwell or confused needs 112. A very painful, swollen lump that is growing quickly, especially with a fever, may need draining in person and needs prompt care.
Can an online doctor treat hidradenitis suppurativa?
Partly. Hidradenitis suppurativa is diagnosed from the type of lumps, where they appear and how they keep coming back, so a doctor by video, with your photos and history, can often recognise it. The doctor can start the first-line treatments, such as antiseptic washes, antibiotic creams and long courses of antibiotic tablets, help with pain, and plan for flares. An abscess that needs draining, specialist medicines, biologic injections and surgery are given in person, and the doctor tells you when to be referred. You choose what you show on camera.
How an online consultation helps with hidradenitis suppurativa
- A name for it: HS is often mistaken for repeated boils. The doctor checks the pattern of your lumps with you.
- Fewer new lumps: Antiseptic washes, antibiotic creams and long courses of tablets that reduce new lumps.
- Pain and flares: Pain relief that suits you, and a plan for what to do at the first sign of a flare.
- The right specialist: When to see a dermatologist for stronger treatment, and what biologics and surgery involve.
What the doctor checks in an online consultation
The doctor asks about:
- The lumps: where they are, how often they appear, whether they leak pus, and how long this has been going on.
- Tunnels and scars: channels under the skin that leak, and scarring from old lumps.
- Pain: how much it affects walking, sitting, work and sleep.
- Triggers: periods, friction from clothing and shaving.
- Your health: weight, smoking, diabetes, polycystic ovary syndrome, and bowel symptoms such as diarrhoea or tummy pain.
- Treatment so far: antibiotics, washes and creams, drainage, and how they worked.
Before the call, find a private space. Photos of the lumps, taken during a flare, help the doctor see the pattern.
Hidradenitis suppurativa symptoms
Symptoms range from mild to severe. HS often starts with a single painful, pea-sized lump under the skin that lasts weeks or months, and blackheads in small pitted areas, often in pairs. Lumps can break open and drain pus that may smell, and tunnels can form under the skin, linking the lumps and leaking blood and pus. Pus does not always mean infection. The lumps usually appear where skin rubs together:
- the armpits
- the groin and genitals
- on and around the anus and buttocks
- below the breasts
- sometimes the nape of the neck, the waistband and the inner thighs
How severe is it?
Doctors describe the severity in three stages:
Swipe sideways to compare →
| Stage | What it looks like |
|---|---|
| Stage 1 (mild) | Lumps and abscesses that come and go, without tunnels or scarring |
| Stage 2 (moderate) | Repeated abscesses, with tunnels under the skin and scarring |
| Stage 3 (severe) | Many tunnels joined together across a whole area, with scarring |
Early recognition and treatment help stop it getting worse. Repeated boils in the same places are a reason to ask about HS: a single skin abscess or carbuncle is different, and red spots around hairs after shaving are often folliculitis.
What causes hidradenitis suppurativa?
The exact cause is unknown, but the lumps develop from blocked hair follicles that become inflamed. It is not an infection, it is not contagious, and it is not linked to poor hygiene. It affects about 1 in 100 people: studies in Denmark and France both found 1%. Women get it about three times as often as men, it is more common in Black people, and it usually starts after puberty and before 40, most often in the late teens and twenties.
It is more likely, or more severe, with:
- smoking, which is strongly linked to it: in one study, 88.9% of people with HS smoked
- excess weight, which also makes symptoms worse
- a family history: 30% to 40% of people with HS have a relative with it
- friction from tight clothing
- hormonal changes: in some women, HS gets worse before a period
HS is linked with other conditions, including type 2 diabetes, polycystic ovary syndrome, inflammatory bowel disease such as Crohn’s disease, depression and anxiety, so the doctor may suggest checks.
Does hidradenitis suppurativa go away, and is it dangerous?
HS cannot be cured, but treatment can control it, prevent new lumps and treat existing ones. It can become quieter over time, for example after the menopause, but scars remain, and once tunnels and scarring have formed, they do not reverse. That is why early treatment matters. Many people live with HS for years before it is diagnosed, because it is often mistaken for boils, acne, cysts or ingrown hairs.
HS is rarely life-threatening. The main risk is a serious infection. Long-standing HS can rarely lead to other complications:
- a squamous cell skin cancer in scarred skin, most often around the anus or in the groin, so a sore that changes or will not heal needs checking
- swelling of the arms, legs or genitals when scarring blocks lymph drainage
- anaemia, and stiff or painful movement where scars cross the armpits or thighs
People with HS also have a higher risk of arthritis, diabetes and heart disease, and nearly 60% say it has a large or extremely large effect on their life.
Which hidradenitis suppurativa treatment might the doctor recommend?
Treatment depends on how severe HS is and how it affects your life. This is the framework the doctors use, in line with NHS and dermatology guidance.
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Occasional lumps (stage 1) | Antiseptic wash and an antibiotic cream | Yes | Not usually needed |
| Frequent lumps or flares | Antibiotic tablets for at least 3 months | Yes | If it does not improve |
| Flares before periods | Hormonal treatment, such as a contraceptive pill | Yes | Not usually needed |
| A single, very painful abscess | Drainage | Yes, to assess | For the drainage |
| Tunnels and scarring (stage 2 or 3) | A dermatologist’s care: stronger antibiotics, biologics, surgery | Yes, to assess and plan | For specialist treatment |
Painful lumps keep coming back? A doctor can recognise the pattern and start treatment in one consultation.
See available times →Treatment options for hidradenitis suppurativa
What you can do yourself
- Stop smoking: it is one of the strongest triggers.
- Lose weight if you are overweight; this can reduce symptoms.
- Use an antiseptic wash or soap on the affected skin.
- Hold a warm flannel on a lump to help pus drain.
- Wear loose clothing, and avoid shaving the affected skin.
- Use paracetamol or an anti-inflammatory painkiller such as ibuprofen for pain, following the leaflet.
Prescription treatment
A prescription is never issued without a consultation. The doctor may prescribe an antiseptic wash, such as chlorhexidine, and an antibiotic lotion, such as clindamycin, for mild HS. For more frequent lumps, low-dose antibiotic tablets from the tetracycline group, such as doxycycline or lymecycline, are taken for at least 3 months to reduce new lumps, and the response is reviewed after about 12 weeks. A short course of antibiotics treats a lump that has become infected. For women whose HS flares before a period, a contraceptive pill may help. If the doctor prescribes, use the prescription at a pharmacy near you.
Specialist treatment
For severe HS, dermatologists use combinations of antibiotics, such as clindamycin with rifampicin, retinoid tablets such as acitretin, and biologic medicines given by injection. Three biologics are licensed for HS: adalimumab, secukinumab and bimekizumab. In their trials, about 41% to 60% of people on adalimumab, 42% to 46% on secukinumab and 48% to 52% on bimekizumab at least halved their number of painful lumps and abscesses, compared with 26% to 32% on a placebo.
Surgery can open up or remove tunnels and affected skin. In deroofing, the roof of a tunnel is removed so that it heals from the base, which takes several months. Laser hair removal may help some people with less inflamed HS. Retinoids cannot be used in pregnancy, and pregnancy must be avoided for 3 years after stopping acitretin.
What does not help
Squeezing lumps pushes inflammation deeper. Lancing an abscess gives quick relief, but lumps almost always come back in the same place, so treatment that reduces new lumps matters more. Tight clothing and shaving the affected skin make it worse.
Living with hidradenitis suppurativa
HS can affect daily life a great deal: pain, leaking lumps and dressing changes can make work, exercise, sex and sleep harder, and low mood and anxiety are common. Speak to a doctor if you are finding it difficult to cope; support for depression or anxiety is part of treating HS well.
- Keep a short diary of flares, with photos, to see what helps and what triggers them.
- Keep dressings, an antiseptic wash and pain relief ready for the first sign of a flare.
- Ask about stop-smoking and weight support: both can reduce symptoms.
- Review the plan with a doctor if flares become more frequent or stop responding.
Special situations
Pregnancy and breastfeeding
Several HS treatments, including tetracycline antibiotics and retinoids, are not used in pregnancy, so tell the doctor if you are pregnant, trying to conceive or breastfeeding.
Bowel symptoms
HS is linked with Crohn’s disease. Ongoing diarrhoea, tummy pain, blood in your poo or weight loss need checking.
A pit at the top of the buttocks
Many people with HS also develop a pilonidal sinus, a small hole or tunnel in the skin at the top of the buttocks that can become infected.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When hidradenitis suppurativa is treated online, and when you need in-person care
Treated online: recognising HS, antiseptic washes and antibiotic creams, long courses of antibiotic tablets, hormonal treatment, infected lumps, pain relief, flare plans, and support with weight, smoking and mood.
In-person care: drainage of an abscess, specialist medicines such as retinoids and biologics, surgery and laser treatment, HS with tunnels and scarring, and spreading infection in someone who is unwell.
When to get in-person care
Call 112 or go to an emergency department now for:
- spreading redness with a high temperature, shivering, or feeling very unwell, faint or confused
Get medical advice the same day for:
- a very painful, swollen lump that is getting bigger quickly, especially with a fever
- redness spreading out from a lump
- a flare with a high temperature while taking a biologic or other medicine that weakens the immune system
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about HS: describe where the lumps appear and how often, share photos from a flare if you have them, and list the treatments you have tried.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s hidradenitis suppurativa? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Skin abscess can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about hidradenitis suppurativa
What is hidradenitis suppurativa?
Hidradenitis suppurativa, or HS, is a long-term inflammatory skin condition that causes painful lumps, abscesses, tunnels under the skin and scarring, usually in the armpits, groin and around the bottom.
Is hidradenitis suppurativa caused by poor hygiene?
No. Hidradenitis suppurativa is not linked to poor hygiene and it is not contagious. The lumps start in blocked hair follicles, and smoking, excess weight and family history all play a part.
Can hidradenitis suppurativa be cured?
There is no cure for hidradenitis suppurativa, but treatment can greatly reduce new lumps and ease pain, and some people reach long periods with no flares; biologic medicines and surgery to remove the affected skin give the best long-term control in severe disease. Stopping smoking and losing excess weight also help, and they make every other treatment work better.
Will HS ever go away?
HS is a long-term condition, but it can become quieter over time, for example after the menopause, and treatment keeps it under control. Scars and tunnels that have already formed do not go away on their own.
What does HS smell like?
Lumps that break open can drain pus with an unpleasant smell, which is more common when HS is very inflamed. The pus does not always mean infection, and treatment that reduces new lumps reduces the leaking.
Can hidradenitis suppurativa kill you?
It is rarely life-threatening. The main risk is a serious infection, and long-standing HS can rarely lead to a squamous cell skin cancer in scarred skin, so spreading redness with a fever, or a sore that will not heal, needs a doctor.
What is the best treatment for hidradenitis suppurativa?
It depends on severity. Mild HS is treated with antiseptic washes and antibiotic lotion, more frequent lumps with antibiotic tablets for at least 3 months, and severe HS by dermatologists with biologics or surgery.
Can hidradenitis suppurativa flares be prevented?
Not entirely, but far fewer: stop smoking, which is the strongest trigger that can be changed; lose excess weight; wear loose cotton clothing and avoid tight waistbands and underwired bras that rub; use an antiseptic wash on the affected areas; avoid shaving over active lumps and consider laser hair removal; keep the folds dry; and stay on the long-term treatment the doctor prescribes rather than stopping between flares. Women whose hidradenitis suppurativa flares before periods may be offered hormonal treatment.
Can I drain HS lumps at home?
Do not squeeze or cut HS lumps: squeezing pushes the inflammation deeper. A warm flannel can help pus drain on its own, and a very painful abscess may need draining by a doctor.
Is HS the same as boils?
HS lumps look like boils, but they keep coming back in the same areas, form tunnels under the skin and leave scars. Repeated boils in the armpits or groin are a reason to ask about HS.
Does losing weight help hidradenitis suppurativa?
Yes. Excess weight is strongly linked to hidradenitis suppurativa and makes symptoms worse, partly through friction and sweat in the skin folds and partly through inflammation, so losing weight, along with stopping smoking, can reduce flares and improve the response to treatment; some people see a clear difference after substantial weight loss.
Is HS linked to other conditions?
Yes. HS is linked with type 2 diabetes, polycystic ovary syndrome, Crohn’s disease, depression and anxiety, and with the combination of high blood pressure, high cholesterol and excess weight, so the doctor may suggest checks for blood sugar and cholesterol and ask about mood; treating these conditions improves overall health and sometimes the skin too.
Can an online doctor treat hidradenitis suppurativa?
Partly. A doctor can recognise HS, start antiseptic washes, antibiotic lotions and tablets, and help with pain and flares. Drainage, specialist medicines and surgery are done in person.
- Hidradenitis suppurativa, NHS, National Health Service (UK), reviewed 17 March 2023.
- Hidradenitis suppurativa, DermNet, New Zealand, reviewed August 2025.
- Hidradenitis suppurativa: symptoms and causes, Mayo Clinic, updated 21 March 2025.
- Hidradenitis suppurativa: overview, American Academy of Dermatology Association, updated 1 June 2026.
- European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa, Zouboulis CC et al., European Dermatology Forum, published in JEADV 2015.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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