Hidradenitis Suppurativa ICD-10: L73.2

Chronic inflammatory skin disease

Often searched as: painful boils that keep coming back, recurring lumps in armpit, bumps in groin that won't heal, boils under breast, painful cysts armpits, skin tunnels under arms, recurring abscess same spot, HS skin disease…

Clinical urgency level

lowmediumhigh

Systems Affected

skinhair folliclesapocrine glandslymph nodes (in advanced disease)

Severity Levels

mild

Hurley Stage I — isolated abscesses without scarring or sinus tracts; responds to topical treatment.

moderate

Hurley Stage II — recurrent abscesses with sinus tract formation and scarring, in one or more regions.

severe

Hurley Stage III — diffuse or broad involvement with multiple interconnected sinus tracts and extensive scarring across entire regions; significantly impacts quality of life.

Red Flags

  • Rapidly spreading cellulitis around existing lesions
  • Fever and systemic signs suggesting secondary infection or sepsis
  • New or expanding sinus tracts in unusual areas
  • Significant restriction of movement (e.g., arm abduction) due to axillary scarring
  • Non-healing wounds or fistulas
  • Squamous cell carcinoma arising within chronic HS lesions (rare but serious — any non-healing, verrucous, or ulcerated lesion in chronic HS should be biopsied)

Clinical Presentation

Hidradenitis suppurativa Hurley Stage II in the axilla with sinus tracts and scarring

Hidradenitis suppurativa Hurley Stage II in the axilla with sinus tracts and scarring

Source: Wikimedia Commons (CC BY-SA 3.0 — verify attribution requirements)

When to See a Doctor

See a dermatologist or general practitioner if you have recurring, painful boils or nodules in the armpits, groin, buttocks, or under the breasts — especially if they heal poorly, leave scars, or are accompanied by tunneling under the skin. Early diagnosis is key to preventing disease progression and permanent scarring.

Differential Diagnosis

  • Furuncles / carbuncles (recurrent boils)
  • Crohn's disease (perianal fistulas — can coexist)
  • Pilonidal cyst (gluteal/coccygeal region)
  • Lymphogranuloma venereum (inguinal)
  • Acne conglobata (truncal involvement)
  • Bartholin gland abscess (vulvar region)
  • Cat scratch disease
  • Infected epidermoid cysts

Comorbidities

  • Obesity (major modifiable risk factor)
  • Metabolic syndrome and type 2 diabetes
  • Inflammatory bowel disease (Crohn's disease — 20% association)
  • Polycystic ovarian syndrome (PCOS)
  • Depression and anxiety (severe impact on quality of life)
  • Acne conglobata and follicular occlusion triad
  • Cardiovascular disease

Prognosis

HS is a chronic, relapsing disease with no definitive cure. Early intervention can prevent severe scarring and disease spread. Weight loss and smoking cessation are among the most impactful lifestyle changes. Biologic therapies (adalimumab, secukinumab) have significantly improved outcomes in moderate-to-severe disease. Surgical options (wide excision) offer long-term remission in localized areas. Quality of life is heavily affected — comparable to conditions like psoriasis, rheumatoid arthritis, or depression.

Detailed Overview

Causes, Symptoms, and When to Take Action Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent nodules, abscesses, and scarring in areas rich in apocrine glands. How It Looks Texture: Tender, painful nodules or abscesses that may drain pus Color: Red or inflamed, sometimes with dark coloration in chronic lesions Shape: Fluctuant, firm nodules or tunnels (sinus tracts) under the skin Location: Common in axillae (underarms), groin, buttocks folds, under breasts Why Does It Appear? Involves inflammation of hair follicles and apocrine glands Genetic predisposition and environmental factors play a role Contributing factors include smoking, obesity, friction, and perhaps hormonal influences Disease progression leads to formation of tunnels and scarring Should You Be Concerned? Yes. HS can significantly impact quality of life: Pain, drainage, and odor can be distressing Recurrent episodes and scarring can limit mobility and function Risk of secondary infections or complications If you experience recurring painful nodules in typical areas that heal poorly, it's important to see a dermatologist or general practitioner (GP). Can You Prevent It? Weight control and smoking cessation may help reduce severity Minimizing friction and irritation in affected areas Early recognition and care of inflamed nodules 👉 How Piel AI Can Help Piel AI can assist in monitoring lesion number, location, and healing via serial photos. While not diagnostic, it helps detect worsening patterns or new areas requiring evaluation. Summary Hidradenitis suppurativa is a chronic inflammatory disease of hair follicles and apocrine glands. Presents with painful nodules, abscesses, and sinus tracts in folds like armpits and groin. Genetic and lifestyle factors contribute. Early care, lifestyle changes, and monitoring are crucial.

Tags

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