Hidradenitis Suppurativa: Symptoms, Treatment and Herbal Ingredient Evidence
Evidence-informed hidradenitis suppurativa guide
Hidradenitis suppurativa, or HS, is a chronic inflammatory skin disease that can cause painful nodules, abscesses, draining tunnels and scarring, usually in areas such as the armpits, groin, buttocks and under the breasts. Early diagnosis matters because repeated inflammation can lead to permanent tunnels and scars.
Quick reference: hidradenitis suppurativa
| Question | What is established | What this means | Source |
|---|---|---|---|
| Is HS an infection? | HS is primarily a chronic inflammatory follicular disease | Bacteria can complicate lesions, but infection is not the whole disease | AAD |
| What treatments are used? | Topical and oral medicines, hormonal therapy, biologics, procedures, surgery and wound care | Treatment is matched to severity and lesion type | AAD |
| What biologics are available? | Adalimumab, secukinumab and bimekizumab are FDA-approved options for appropriate patients | Moderate-to-severe HS now has several targeted systemic treatments | AAD |
| Do tunnels matter? | Persistent draining tunnels can indicate more established disease | Procedures or surgery may be needed when medication alone is not enough | Dermatology assessment |
Symptoms and diagnosis
HS typically causes recurring painful lumps in skin folds or other friction-prone areas. Over time, repeated inflammation can lead to abscesses, tunnels beneath the skin and permanent scarring.
- Painful inflammatory nodules
- Abscesses
- Draining tunnels or sinus tracts
- Scarring
- Recurring lesions in characteristic locations
Severity is sometimes described using Hurley staging, but real treatment decisions also consider pain, drainage, lesion type, number of affected areas and quality-of-life impact.
Risk factors and common body sites
HS can affect anyone, but several factors are associated with higher risk or more severe disease. Family history is common, smoking is associated with HS, and excess body weight can increase friction and occlusion in skin folds. These associations do not mean that HS is simply caused by hygiene, weight or smoking.
Typical sites include the armpits, groin, inner thighs, buttocks, under the breasts and other areas where skin rubs together. Repeated lesions in the same characteristic locations are an important diagnostic clue.
Understanding Hurley stages
Hurley staging is a simple way clinicians describe structural disease severity:
- Hurley I: one or more abscesses or inflammatory nodules without persistent tunnels or widespread scarring.
- Hurley II: recurrent lesions with tunnels and scarring, but separated areas of normal skin remain between them.
- Hurley III: extensive interconnected tunnels, abscesses and scarring across an affected region.
What this means: staging helps describe how much permanent structural change has developed, but treatment also depends on pain, drainage, active inflammation and quality-of-life impact.
Established treatment options
Topical and oral medicines
Topical clindamycin may be used in selected milder cases. Oral antibiotics are also commonly used because they can reduce both bacteria and inflammation. Hormonal options, including spironolactone in appropriate patients, may also be considered.
Biologics
For moderate-to-severe disease, biologic treatment can reduce inflammatory lesions. The AAD currently lists adalimumab, secukinumab and bimekizumab among FDA-approved biologic options for appropriate HS patients. AAD treatment guide
What this means: HS treatment has moved well beyond antibiotics alone. Targeted immune therapies are now an established part of care for more severe disease.
Procedures and surgery
Deroofing, laser procedures and surgery can be useful for persistent tunnels, recurring lesions or scarred areas that continue to flare. These approaches physically address diseased tissue that may not respond fully to topical treatment.
Botanical ingredient research relevant to HS skin care
Research on traditional botanical ingredients can be useful for understanding inflammation, itch and topical sensory effects. These studies are most informative when the actual result is stated clearly.
| Ingredient | What researchers found | What this means | Evidence |
|---|---|---|---|
| Ku Shen | Selected Sophora compounds reduced inflammation and improved psoriasis-like skin changes in experimental models | Ku Shen has positive anti-inflammatory skin research | PMID 38358770 |
| She Chuang Zi | Osthole reduced scratching in experimental itch models by blocking TRPV3 | Cnidium contains a compound with a clear itch-related effect in preclinical research | PMID 30108138 |
| Borneol | Topical borneol produced greater pain relief than placebo in a randomized human study and has also been studied in topical-delivery systems | Borneol has human sensory evidence plus formulation research | PMC5452010 |
| Stemonae Radix | Several isolated Stemona alkaloids reduced signs of inflammation in laboratory cells | Stemona contains compounds with positive anti-inflammatory findings | PMID 35295975 |
Where QICAOGANGMU fits
QICAOGANGMU is a steroid-free botanical topical containing Ku Shen, She Chuang Zi, Borneolum Syntheticum, Stemonae Radix and Menthol. The ingredient research gives the formula a scientific context around inflammation, itch and topical sensory effects.
Read the ingredient and safety reviewWhen procedures or surgery are considered
Medication can reduce inflammation, but established tunnels and repeatedly inflamed scarred areas may need procedures. Deroofing opens chronic tunnels so they can heal from the base, while wider surgery can remove severely affected tissue. Laser-based approaches may also be considered in selected cases.
What this means: surgery is not a sign that medical treatment has "failed." Structural disease such as tunnels can require a physical solution in addition to medicines that control inflammation.
Skin care and wound care
- Reduce friction where possible: loose clothing and friction-reduction strategies can improve comfort.
- Follow a wound-care plan: dressings and cleansing needs vary according to drainage and wound condition.
- Do not put ordinary cosmetic products directly into draining tunnels or open abscesses: these areas may need specific wound care.
- Watch for infection: rapidly worsening redness, fever, increasing warmth or significant drainage needs prompt assessment.
Frequently asked questions
Can HS go away on its own?
HS is usually a chronic condition. Symptoms can vary over time, but recurrent nodules, abscesses or tunnels deserve treatment rather than repeated self-treatment alone.
Are antibiotics the only treatment?
No. Modern HS care can also include hormonal therapy, biologics, procedures, surgery and individualized skin and wound care.
When should I see a dermatologist?
Recurring painful lumps, drainage, tunnels, scarring or lesions in the armpits, groin, buttocks or under the breasts are good reasons to seek assessment.
Can botanical products be used on HS-prone skin?
On intact skin, a botanical topical may be considered according to its directions and individual tolerability. Open, draining or infected-looking lesions should follow a clinician-directed wound-care plan.
Related articles
Clinical references
- American Academy of Dermatology. Hidradenitis suppurativa: diagnosis and treatment. AAD guide
- Lin CF et al. Anti-inflammatory activity of flavonoids and alkaloids from Sophora flavescens. PMID 38358770
- Sun XY et al. Antipruritic effect of osthole through selective inhibition of TRPV3. PMID 30108138
- Dai H et al. Topical borneol-induced analgesia and enhanced transdermal delivery. PMC5452010
- Xu Y et al. Alkaloids from Stemona tuberosa and their anti-inflammatory activity. PMID 35295975