Hidradenitis Suppurativa – Consultant Diagnosis & Long-Term Treatment in London

What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a long-term skin condition characterised by painful lumps and abscesses, most often in skin folds such as the armpits, groin, buttocks, and under the breasts. Over time, tunnels (sinus tracts) and scarring may form. HS is not an infection or caused by poor hygiene but by inflammation of hair follicles and the immune system.

Causes and how it develops

HS occurs due to blockage and inflammation of hair follicles, followed by immune activation and bacterial involvement. While the exact cause is not fully understood, genetic predisposition, hormones, smoking, obesity, and immune dysregulation play important roles. It often begins in late adolescence or early adulthood.

HS Symptoms and disease course

HS typically starts with recurrent painful lumps resembling boils. These may burst, release pus, and heal slowly, often leaving scars. As the disease progresses, sinus tracts and interconnected abscesses can form, causing persistent pain, odour, and skin damage. Flares are unpredictable and often triggered by hormonal cycles, stress, or friction.

HS Diagnosis and tests

Diagnosis is clinical, based on history and examination. Dermatologists look for recurrent nodules in typical sites with scarring and sinus tracts. Tests may include swabs to check for infection or blood work to exclude other inflammatory conditions. Imaging is sometimes used for deep disease assessment.

HS Treatment options and management

Medical treatments

Topical antibiotics (e.g., clindamycin) can help in early or mild HS. Oral antibiotics such as tetracyclines or combination regimens reduce inflammation. Hormonal therapies may help women with hormonally linked flares. Biologics (e.g., adalimumab) are effective for moderate to severe HS.

Procedures and surgery

Drainage of abscesses may give temporary relief but is not curative. Laser hair reduction or carbon dioxide laser surgery can help in chronic HS. Wide surgical excision may be needed for advanced disease with extensive scarring and tunnels.

Lifestyle and supportive care

Lifestyle measures such as weight optimisation, smoking cessation, wearing loose clothing, and stress reduction can reduce flare frequency. Pain management and psychological support are also key to holistic care.

When urgent review is needed

Seek urgent medical help if HS lesions cause spreading redness, fever, severe pain, or sudden worsening, as this may indicate infection or require emergency care.

Why choose Skinhorizon for hidradenitis suppurativa?

• Consultant dermatologist-led diagnosis and staging of HS severity.
• Access to advanced therapies including biologic injections and laser treatments.
• Integrated support for long-term disease management under CQC standards.

Your first visit — what to expect

1. History: Onset, triggers, family history, lifestyle, hormonal and menstrual patterns.
2. Examination: Distribution, number of lesions, scarring, and staging of HS.
3. Discussion: Education about HS, treatment options, and long-term management.
4. Treatment plan: Stepwise strategy including medical therapy, lifestyle advice, and procedural options.
5. Follow-up: Regular reviews to monitor response, adjust medication, and prevent complications.

Reviewed by: Dr Mohammad Ghazavi, Consultant Dermatologist
Skinhorizon Clinic, 4 Clarendon Terrace, Maida Vale, London W9 1BZ
Last reviewed: 21 August 2025