Hidradenitis Suppurativa ICD-10: L73.2
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
Systems Affected
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
Source: Wikimedia Commons (CC BY-SA 3.0 — verify attribution requirements)
HS lesion gallery — DermNet NZ
View gallery on DermNet NZ (image gallery reference)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
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