Hydradenitis Suppurativa: More than just a cosmetic issue
- julirestrepo546
- Nov 13, 2025
- 3 min read
What is Hydradenitis Suppurativa (HS):
Hydradenitis Suppurativa (HS) is an inflammatory disease which causes formation of nodules, abscesses, ulcers, excessive scarring, and inflamed sinus tracts (a.k.a tunnels). Lesions are primarily found in the axillae, the groin, the inframammary region, and general areas where the surfaces of the skin rub against each other. As a result of the lesions, patients suffer with chronic pain, odor emitted from the lesions on the skin, and persistent inflammation. In addition to physical symptoms, there are also psychological effects, with HS patients being at 2 times greater odds of depression and anxiety. While there is a genetic component to HS in some patients, HS is primarily triggered by external factors including smoking, hormonal imbalance and obesity.
Severity:
Severity of HS is assessed using the Hurley scoring system due to its ease in clinical practice. As the Hurley scoring system lacks a quantitative measure, there are additional scoring measures that may provide more accuracy, including the Sartorius Scoring system which takes into consideration measures of lesion quantity, diameter, distance and region. Clinically, the Hurley scoring system is most commonly used to indentify and categorize HS into three different stages.
Stage 1: Formation of abscesses but lacking tunnel formation
Stage 2: recurring abscesses, tunnel formation, with measurable distance between lesions separated by normal skin
Stage 3: Large or multiple abscesses spanning the area, interconnection of tunnels, severe scarring, with limited visible normal skin in the area.
Currently, diagnosis of HS is made via physical examination, however patients are often misdiagnosed at early stages as during this time the lesions observed resemble lesions seen in other illnesses.
Treatments:
HS, as an inflammatory disease, displays an increase of inflammation inducing proteins, known as cytokines, that can aid in the recruitment of immune cells to the skin and promote inflammation. Due to the chronic pain induced by HS, some therapies focus on pain management through the use of analgesics, however these treatments do not directly act on treating HS. In HS, bacteria present in the area can trigger further inflammation, therefore antiseptics and antibiotics are also used to treat HS. Topical antibiotics are used to treat stage 1 and 2, while systemic antibiotics are used in stages 2 and 3. In more severe cases of HS, treatments targeting immune factors are showing to be promising. At the site of inflammation, the increase presence of cytokines act as therapeutic targets using biologics. Currently, Adalimumab is approved for the treatment of HS and in clinical trials has displayed 50% reduction in lesions and inflammation. Other biologics are being assessed for their potential in treating HS, however further studies are needed to determine efficacy and dose. Many of the treatments for HS do not provide a permanent cure, therefore for patients with little success in treating their HS, surgical therapy may be considered. Surgical procedures may vary but involve opening the lesions and either partially or fully removing the lesions, allowing for proper healing. While current therapies aid in treating patients with HS, the need to diagnose patients at earlier stages remains. Early diagnosis of HS would prevent patients from suffering irreversible damage from lesions that arise, however further studies are needed to understand HS.
1. Lewandowski, Miłosz et al. “Hidradenitis suppurativa: a review of current treatment options.” International journal of dermatology vol. 61,9 (2022): 1152-1164. doi:10.1111/ijd.16115
2. Scala, Emanuele et al. “Hidradenitis Suppurativa: Where We Are and Where We Are Going.” Cells vol. 10,8 2094. 15 Aug. 2021, doi:10.3390/cells10082094
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