Hidradenitis Suppurativa (HS): Symptoms, Stages, Treatment and Daily Skin Care
Skin condition guide
Hidradenitis suppurativa (HS) is a long-term inflammatory skin disease that causes painful, recurring lumps, abscesses and, over time, draining tunnels and scars in skin folds such as the armpits, groin, buttocks and under the breasts. It affects around 1% of people, usually starting in early adulthood. It is not caused by poor hygiene and is not contagious. Early diagnosis and treatment matter, because repeated inflammation can cause permanent tunnels and scarring.
- Not an infection or hygiene problem: it starts with blocked, inflamed hair follicles.
- Risk factors: genetics, smoking, excess weight and hormones.
- Treatments: antiseptic washes, antibiotics, hormonal therapy, biologics, procedures and surgery, matched to severity.
- Daily care: gentle cleansing, loose clothing, friction reduction and soothing care of intact skin.
What is hidradenitis suppurativa?
HS, also called acne inversa, is a chronic inflammatory disease of the hair follicles in skin folds. Inflammation driven by immune signals such as TNF, IL-1β and IL-17 leads to painful nodules, abscesses and tunnels that discharge pus. It is linked to metabolic and cardiovascular conditions and has a major effect on quality of life (Sabat et al., 2020). Prevalence estimates vary between populations (Jfri et al., 2021), with about 1% often quoted.
What are the early signs of HS?
- Painful, pea-sized lumps under the skin that come back in the same places
- Lumps that swell, open and leak pus or blood, then heal slowly
- Blackheads in pairs ("tombstone" comedones) in skin folds
- Tunnels under the skin and rope-like scars over time
- Flares with heat, sweat, friction, stress or periods
HS is often mistaken for boils or ingrown hairs for years. Recurring "boils" in the same fold area are a reason to ask about HS.
What are the Hurley stages of HS?
| Stage | What it looks like | Usual approach |
|---|---|---|
| Hurley I (mild) | Single or few lumps or abscesses, no tunnels or scars | Topical treatment, antiseptic washes, lifestyle changes |
| Hurley II (moderate) | Recurrent lumps with some tunnels and scarring, separated by normal skin | Oral antibiotics, hormonal therapy, biologics, minor procedures |
| Hurley III (severe) | Widespread interconnected tunnels and scarring | Biologics plus surgery |
What causes HS?
A genetic tendency, smoking, obesity and hormonal factors are established contributors (Sabat et al., 2020). Friction and sweat in skin folds can trigger flares. HS is not caused by being unclean.
How is HS treated?
North American guidelines recommend combining medical and procedural care, chosen by stage and lesion type (Alikhan et al., 2019, Part II; Part I):
- Topical and wash treatments: clindamycin solution, benzoyl peroxide or chlorhexidine washes for mild disease.
- Oral antibiotics: tetracyclines, or clindamycin with rifampicin, for their anti-inflammatory effect.
- Hormonal and metabolic options: such as spironolactone or metformin in selected patients.
- Biologics: adalimumab, secukinumab and bimekizumab are approved in the US for moderate to severe HS.
- Procedures: steroid injections into painful nodules, deroofing of tunnels, laser and surgical excision.
- Lifestyle: stopping smoking and weight management support treatment.
Comfort for skin between HS flares. QICAOGANGMU pairs cooling borneol and menthol with Ku Shen and She Chuang Zi, tested steroid-free by TÜV SÜD PSB. Rated 4.5 to 4.7 out of 5 on Amazon. See the formula
What daily skin care helps HS?
- Wash gently with a mild cleanser or the antiseptic wash your doctor recommends; no scrubbing.
- Reduce friction with loose, breathable clothing and seamless underwear.
- Keep folds cool and dry; change out of sweaty clothes quickly.
- Avoid shaving over active lumps; trim instead.
- Dress draining lesions with absorbent, non-stick dressings.
- Soothe intact surrounding skin. Keep moisturisers and soothing creams to unbroken skin around lesions, never on open or draining wounds.
For care of red, sore folds without HS, see intertrigo, and for psoriasis in folds, inverse psoriasis.
When should you see a doctor?
- Lumps that keep coming back in the armpits, groin or buttocks
- Pain that disturbs sleep or daily life
- Draining tunnels or scarring
- Fever, spreading redness or feeling unwell
Early dermatology care can prevent tunnels and scars.
Where QICAOGANGMU fits
QICAOGANGMU Steroid-Free Herbal Cream
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QICAOGANGMU is a steroid-free herbal cream with She Chuang Zi 3%, Bing Pian (borneol) 2%, Ku Shen 1.5%, Bai Bu 0.5% and menthol 0.5% in a moisturising glycerin and petrolatum base, for comfort of intact, itchy or irritated skin in folds between flares. It complements, not replaces, your HS treatment. Do not apply to open or draining lesions.
- Steroid-free: TÜV SÜD PSB found none of 8 corticosteroids (lab reports)
- Fully declared formula: every active ingredient and its percentage on the label
- 100-day money-back guarantee
- US shipping in 2 to 6 business days, free over US$20
Patch test on a small area first, use a thin layer on intact skin and avoid the eyes, lips and genitals. Skin-fold care · Product details
Frequently asked questions
What is the main cause of hidradenitis suppurativa?
HS starts with blocked, inflamed hair follicles in skin folds. Genetics, smoking, excess weight and hormones are major contributors. It is not caused by poor hygiene.
Is hidradenitis suppurativa contagious?
No. HS is an inflammatory disease and cannot spread to other people.
Can HS be cured?
HS is chronic, but treatment with medicines, biologics and procedures can control flares and prevent new tunnels and scars, especially when started early.
What is the best treatment for HS?
It depends on the stage: washes and topical treatment for mild HS, oral antibiotics or hormonal therapy for moderate HS, and biologics with surgery for severe HS.
Can I use QICAOGANGMU on HS?
Only on intact skin around affected areas, for comfort between flares and after a patch test. Never apply it to open, draining or infected lesions, and keep following your doctor's plan.
Related articles
References
- Sabat R, Jemec GBE, Matusiak Ł, et al. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020;6(1):18. PMID 32165620
- Jfri A, Nassim D, O'Brien E, et al. Prevalence of hidradenitis suppurativa: a systematic review and meta-regression analysis. JAMA Dermatol. 2021;157(8):924-931. PMID 34037678
- Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa. Part I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76-90. PMID 30872156
- Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa. Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101. PMID 30872149
Product information. QICAOGANGMU is a topical herbal skin-care cream and is not a treatment for hidradenitis suppurativa. HS should be diagnosed and managed by a healthcare professional.
