Dermatologist-led HS care · Chaska, Minnesota
Hidradenitis Suppurativa Diagnosis and Treatment
Repeated painful “boils” or “cysts” in the underarms, groin, beneath the breasts, buttocks, or inner thighs may be hidradenitis suppurativa—an inflammatory skin condition that needs a different approach than treating each bump as an isolated event.
Scenic Dermatology provides board-certified dermatologist evaluation for recurrent painful lumps, drainage, openings beneath the skin, and scarring. The first goal is to establish the diagnosis and understand the pattern; treatment is then matched to active inflammation, disease extent, structural changes, age, health, and daily-life impact.
Could this recurring pattern be HS?
Recurrence and location matter more than any single bump.
- Deep, painful lumps return in the same skin folds.
- Lesions drain, heal slowly, or leave scars.
- Openings or tender bands seem connected beneath the skin.
- Antibiotics or drainage help briefly, but new areas keep appearing.
More than a series of isolated bumps
Could Recurring “Boils” or “Cysts” Be Hidradenitis Suppurativa?
HS is a chronic inflammatory disease centered around hair follicles. A dermatologist looks for a pattern: characteristic lesions, characteristic locations, and repeated or persistent disease over time.
The bumps are deep or painful
HS can begin as tender nodules beneath the skin. Some become abscess-like or drain; others settle without opening. Pain may come from inflammation, pressure, an open area, or chronic tenderness.
They return in skin folds
Repeated lesions in an underarm, the groin or inner thighs, beneath a breast, or around the buttocks are more suggestive than one bump in an otherwise unrelated location. Disease can affect one area or several.
Healing leaves evidence
Prior areas may leave dark or light marks, raised or indented scars, paired blackhead-like openings, or tender bands beneath the surface. Ongoing drainage from more than one opening can signal a tunnel.
The cycle keeps restarting
A lesion may improve after it drains or after a course of treatment, yet another forms nearby or in a different fold. That repeated pattern is a reason to look beyond a one-time boil, abscess, ingrown hair, or cyst.
Earlier recognition can help limit new damage without predicting the future. Repeated inflammation can produce tunnels and permanent scars, but not everyone follows the same course. One isolated bump does not mean severe HS is developing.
A body-fold pattern
Where Hidradenitis Suppurativa Commonly Occurs
HS often affects areas where skin touches skin, pressure or friction occurs, or hair follicles are concentrated. The distribution is an important diagnostic clue, although HS is not limited to these locations.
Underarms
One or both underarms may develop deep nodules, draining openings, scars, or tender tunnels. Repeated shaving irritation or “ingrown hairs” in this area can sometimes obscure the larger pattern.
Groin and inner thighs
Lesions can occur along the groin crease, inner thighs, pubic area, or nearby folds. A dermatologist can evaluate these concerns respectfully and distinguish HS from infections, folliculitis, cysts, and other causes.
Beneath the breasts
The fold beneath a breast can be affected by recurrent nodules, drainage, irritation, or scars. Rashes and yeast or bacterial infections can also occur there, so recurrence and lesion type matter.
Buttocks and nearby folds
HS can affect the buttocks, crease between them, or perineal and perianal skin. Some conditions in this region require a different treatment pathway, making examination especially important.
Inflammation, not blame
HS Is Not Simply an Infection—and It Is Not Caused by Poor Hygiene
The underlying HS process is inflammatory. Individual lesions can become secondarily infected, but repeated HS is not a series of unrelated infections and is not caused by being dirty or failing to wash enough.
| Pattern | What it can involve | Why evaluation matters |
|---|---|---|
| Hidradenitis suppurativa | Recurring inflammatory nodules or abscess-like lesions in characteristic areas, sometimes with drainage, tunnels, and scars. | Disease control may require ongoing medical care, procedure planning, or both—not treatment of one opening alone. |
| Isolated skin cyst | A discrete epidermoid or pilar cyst that may remain quiet, inflame, drain, or recur at one site. | Observation, inflammation care, drainage, or planned excision may address that individual lesion. Learn about cyst evaluation and removal. |
| Acute infection or abscess | A bacterial infection or drainable collection may cause rapid pain, warmth, redness, swelling, pus, or systemic symptoms. | Prompt assessment can determine whether drainage, antibiotics, culture, or another step is needed. |
Antibiotics may be used in HS for anti-inflammatory effects, bacterial burden, or a true secondary infection. Their role is different from assuming bacteria are the entire cause. Aggressive scrubbing, harsh antiseptics, or repeated squeezing can further irritate painful skin and will not remove an established tunnel.
HS has also been called acne inversa, but it is distinct from ordinary acne. Deep acne nodules tend to follow an acne distribution and are assessed alongside clogged pores and other acne features; HS is defined by its recurrent fold-area pattern and structural changes.
Do not squeeze, cut, or try to drain a suspected HS lesion at home. Manipulation can increase pain, bleeding, inflammation, infection risk, and scarring while delaying the correct diagnosis.
What can change beneath the surface
Nodules, Drainage, Tunnels, and Scars Do Not All Need the Same Strategy
Some people have occasional inflammatory nodules without tunnels. Others develop persistent connected channels beneath the skin or recurring structural lesions. Medical treatment can reduce inflammation and new activity; an established tunnel may sometimes need a procedure directed at its architecture.
- Deep inflammatory noduleA painful lump forms beneath the surface and may settle, enlarge, or become abscess-like.
- Drainage or repeated inflammationAn area may open and drain, then recur at the same site or nearby.
- Tunnel formationRepeated inflammation can create a channel under the skin with one or more openings. Drainage from the surface does not remove that channel.
- Scar and tissue changeHealing can leave permanent color and texture changes, thick bands, or restricted movement. Controlling active disease remains useful even after scars exist.
This is an orientation model, not an inevitable sequence. HS varies widely. Some people never develop tunnels or extensive scars, and treatment decisions should not be based on a self-assigned stage.
Diagnosis comes before a treatment list
How a Dermatologist Diagnoses Hidradenitis Suppurativa
HS is primarily a clinical diagnosis. There is no single blood test, culture, biopsy, or scan that every patient needs.
- Map the historyReview when the first lesions appeared, how often they return, affected locations, pain, drainage, scarring, family history, prior diagnoses, and what earlier treatments actually changed.
- Examine active and healed areasLook at lesion type, distribution, paired or connected openings, tunnels, scars, and signs that could point to a cyst, folliculitis, acne, infection, pilonidal disease, or another diagnosis.
- Assess extent and impactConsider how many areas are involved, whether tunnels exist, flare frequency, pain, drainage, movement, sleep, school, work, exercise, clothing, and emotional burden.
- Use tests selectivelyA bacterial culture can help when true infection is suspected. Other testing or a biopsy may be used when the diagnosis is uncertain or another condition needs to be excluded.
- Build a follow-up planChoose treatment goals, address active problems, plan monitoring, and adjust over time. HS often needs continuity rather than a one-visit fix.
Photographs and a brief timeline can help. If lesions come and go, consider bringing clear images of prior flares, a list of affected areas, previous culture results, and the names and outcomes of earlier medicines or procedures.
Seek prompt medical care for rapidly spreading redness, fever, feeling ill, severe or rapidly worsening pain, or another concern that feels urgent. HS can coexist with a secondary infection, and not every painful swelling is HS.
Match the plan to the disease pattern
How Hidradenitis Suppurativa Treatment Is Chosen
The useful question is not “Which one HS medicine is best?” Treatment changes when the main problem is an occasional inflamed nodule, frequent new lesions, wider inflammatory disease, a painful acute collection, established tunnels or scars, or several of these at once.
These categories describe the current treatment landscape, not a menu or promise of a specific therapy. An evaluation is needed to confirm what is appropriate and what can be provided through Scenic Dermatology or another setting. Do not start, stop, or change a prescribed treatment based on this page.
One plan can address two kinds of disease
Medical and Procedural HS Care Can Complement Each Other
A procedure is not automatically a failure of medical treatment, and medication cannot always undo established skin architecture. The plan should identify which problem each treatment is meant to solve.
| Main problem | Primary treatment role | Important limitation |
|---|---|---|
| Active inflammation and new lesions | Medical treatment aims to reduce inflammatory activity, flare frequency, pain, and formation of new lesions. | Medicine may not remove a mature tunnel or reverse an existing scar. |
| Persistent tunnel or recurring structural site | A procedure can target altered tissue or a channel beneath the surface. | Treating one site does not control inflammatory activity elsewhere in the body. |
| Both are present | A combined strategy may control active disease while addressing selected structural areas. | Timing, wound care, medication safety, and realistic goals need coordination. |
Scars do not mean treatment has lost value. Reducing new inflammation can still protect unaffected skin, reduce pain and drainage, and support healing. Procedures should be planned around the specific tunnel or scar pattern rather than treating every mark the same way. Scenic’s broader Surgical Dermatology page explains general procedure, wound, and scar planning without replacing an HS-specific assessment.
Practical care without shame or rigid rules
Skin Care, Drainage, Friction, Weight, Smoking, and Diet
Daily strategies should make affected skin easier to live with and support medical care. They should not blame a person for having HS or delay treatment while waiting for a lifestyle change.
Gentle skin and hair care
Wash gently rather than scrubbing. Friction, tight seams, aggressive shaving, waxing, or a product that stings active skin can aggravate symptoms for some people. There is no rule that every person must stop shaving or deodorant; adjust techniques and products to tolerance.
Drainage and wound comfort
Nonstick or absorbent dressings can protect clothing and reduce friction when an area is open. Drainage and odor are medical and practical concerns—not evidence of poor hygiene. A plan may need to account for adhesive irritation, fit, activity, skin folds, and the amount of drainage.
Weight and smoking
Higher body weight and smoking are associated with HS severity in some populations, but neither is a moral failing or the sole cause of disease. If someone wants support with weight or stopping tobacco for broader health reasons, that can occur alongside HS treatment—not as a condition for receiving it.
Diet and supplements
No single diet is established as an HS cure. Some people notice individual associations, but evidence for restrictive dairy-free, yeast-free, or other elimination diets remains limited. Avoid removing major food groups or taking supplements for HS without considering nutrition, health conditions, and medication interactions.
Health and life context belong in the plan
Tell your dermatologist what HS is changing
- Pain, drainage, sleep, mobility, exercise, work, school, clothing, intimacy, or self-image.
- Joint symptoms, persistent bowel symptoms, menstrual or hormonal patterns, or other inflammatory conditions.
- Pregnancy, pregnancy planning, or breastfeeding, because medication choices and timing may change.
- Low mood, anxiety, isolation, or difficulty coping. These effects deserve direct support, not minimization.
Adolescent disease deserves early attention
Hidradenitis Suppurativa in Teenagers
HS often begins after puberty. A teenager may call the lesions ingrown hairs, pimples, cysts, or boils and may hide symptoms because of embarrassment, location, drainage, or odor.
Repeated painful bumps in the underarms, groin, inner thighs, beneath the breasts, or buttocks deserve evaluation even when no lesion is currently severe. Care should account for sports, school attendance, changing clothes, dressing needs, pain, sleep, and the emotional effect of a condition in private body areas. Parents and caregivers can help by treating HS as a medical problem rather than a cleanliness problem.
Age matters when treatment is chosen. Current FDA labeling includes adalimumab, some adalimumab biosimilars, and secukinumab for appropriate patients age 12 and older with moderate-to-severe HS, while bimekizumab’s HS indication is for adults. Exact product labeling, body weight, health history, screening, monitoring, and pregnancy considerations must be checked for the individual patient.
Scenic’s Pediatric Dermatology page explains the practice’s broader approach to children and teenagers. A visit does not commit a young person to a biologic or procedure; it establishes the diagnosis, current extent, and reasonable next steps.
When the pattern keeps returning
When to See a Dermatologist for Possible HS
You do not have to wait for extensive scarring or multiple tunnels before asking whether recurrent boils or cyst-like areas could be HS.
- Painful bumps keep returning in the same underarm, groin, thigh, breast-fold, or buttock area.
- Prior lesions left scars, paired openings, tender bands, or areas that continue to drain.
- Several body areas are involved, or pain and drainage interfere with movement, sleep, school, work, exercise, or clothing.
- You have repeatedly been treated for boils, cysts, abscesses, or infections without durable control.
- A current plan is not adequately controlling new lesions, pain, drainage, or progression.
At the visit, William Miller, MD, MSc, MPH, FAAD, can review the pattern, examine active and healed areas, discuss treatment goals, and explain whether follow-up, medication, a procedure, or care in another setting is appropriate. Because HS changes over time, the useful endpoint is a workable plan—not a promise that one treatment will eliminate every future flare.
Insurance rules can differ for visits, medicines, procedures, laboratory monitoring, and prior authorization. Review Scenic’s insurance information, confirm benefits with your plan, and use the New Patients guide for records, forms, and appointment preparation.
Physician-led care over time
Connect the diagnosis, treatment goals, and follow-up
Dr. Miller is a board-certified dermatologist. Scenic Dermatology’s role begins with an accurate assessment of the person and the disease pattern—not a predetermined drug or procedure. The plan can be revisited as inflammatory activity, life circumstances, tolerance, insurance access, or structural disease changes.
The aims can include fewer new lesions, less pain and drainage, better day-to-day function, protection from additional tunnels or scars, and a clearer response plan when a flare occurs. Improvement can be meaningful even when HS is not completely quiet.
Questions people ask before scheduling
Hidradenitis Suppurativa FAQs
Is hidradenitis suppurativa contagious?
No. HS is not contagious and cannot be spread by touching, sharing clothing, or close contact. It is an inflammatory disease centered around hair follicles, not a hygiene failure.
Is HS the same as recurring cysts?
No. An epidermoid or pilar cyst is a discrete structure that may remain isolated and can sometimes be addressed by removing that individual cyst. HS produces a recurrent inflammatory pattern in characteristic areas and may create multiple lesions, tunnels, drainage, and scars. Examination is important because people often use “cyst” for both.
Is HS an infection?
The underlying HS process is inflammatory, not simply an infection. A lesion can become secondarily infected, and antibiotics may have antimicrobial or anti-inflammatory roles. Repeated HS still requires attention to the chronic disease pattern rather than assuming each lesion is an unrelated bacterial abscess.
Does hidradenitis suppurativa go away?
HS is generally a chronic condition, but its activity can change and treatment can reduce new lesions, pain, drainage, and additional tissue damage. Some people have long quieter periods. No responsible plan can guarantee a permanent cure or predict one person’s course from another’s.
Do antibiotics cure HS?
No. Antibiotics can be useful for selected HS patterns because of anti-inflammatory effects, effects on bacterial burden, or treatment of a true secondary infection. They do not remove an established tunnel or guarantee that future lesions will stop.
What biologic medicines are FDA-approved for HS?
Current FDA-approved biologic options include adalimumab and some adalimumab biosimilars, secukinumab, and bimekizumab for appropriate moderate-to-severe HS. Adalimumab, some of its biosimilars, and secukinumab have indications that include appropriate patients age 12 and older; bimekizumab’s HS indication is for adults. Labels, age and weight requirements, screening, safety considerations, monitoring, insurance, and individual suitability must be reviewed before treatment.
Why can a bump return after it was drained?
Drainage can release fluid and reduce pressure from a selected painful collection, but it does not control inflammatory activity throughout the skin or remove a tunnel beneath the surface. Recurrence is therefore possible, and repeated drainage may signal that the diagnosis or longer-term strategy needs reassessment.
Can teenagers get hidradenitis suppurativa?
Yes. HS often begins after puberty. Recurrent painful lesions in typical fold areas, drainage, or scarring should not be dismissed as poor hygiene or ordinary puberty-related acne. An evaluation can confirm the diagnosis and account for age-specific treatment, school, sports, clothing, pain, and emotional impact.
Does losing weight or changing diet cure HS?
No. HS is not caused by someone’s body size, and no single diet is an established cure. Weight changes may affect severity for some people, and individuals may notice dietary associations, but medical care should not be withheld while waiting for weight loss or a restrictive diet.
What should I bring to an HS appointment?
Bring a medication list, previous treatment names and outcomes, any culture or procedure information, and photographs of earlier flares if the skin is quieter on the appointment day. Note the locations involved, how often lesions return, drainage, scars, pain, and effects on sleep, movement, work, school, exercise, or clothing.
Related care
Continue with the page that matches your next question
A diagnosis-first next step
Request an evaluation for recurring painful bumps, drainage, or scarring
Scenic Dermatology can evaluate whether the pattern fits hidradenitis suppurativa, clarify what is active now, and build a treatment and follow-up plan around your goals.