A patient came into the clinic today and said she had a couple lumps in her left armpit (axilla) that have been very painful and draining some clear liquid. She told me that she had one before in her right arm pit and she had it treated by taking antibiotics and a doctor also performed an incision and drainage.
Hidrandenitis suppurativa (HS) is a condition in which there is red, swollen painful bumps in places where the skin rubs together. The nodules can make it difficult to move because they are so painful. They can also smell foul and drain pus or blood. These bumps may go away on their own, but often stay for weeks to months and often come back.
Causes: This is not caused by being unclean – it’s not an infectious disease. Often the area may become irritated by shaving in that area or a certain deodorant or antiperspirant. You cannot spread this to anyone else as it’s not contagious. It is generally a genetic condition that is more common in first-degree relatives that have the condition.
The bumps or nodules are usually located in the:
1) Armpits (axilla)
2) In the groin
3) Under the breasts (in women)
4) On the inner thighs
5) Buttocks
6) Around or near the anus
Often the skin hardens and scars around the painful nodules and some can form tunnels under the skin.
Treatment: Possible treatment options include:
1) Antibiotic liquids or gels that you put on the affected areas – these actually work to reduce inflammation rather than treat infection
2) Antibiotic pills – to reduce inflammation
3) Injections of steroid medications into the areas to bring down the inflammation
4) Some women take hormone treatments to improve their condition
5) Surgery
Things you can do to reduce your symptoms:
1) If you are overweight, lose weight because this condition is more common or severe in people who are overweight
2) Try to avoid activities that cause your skin to rub against itself
3) Do not wear tight-fitting clothes
4) For people with recurrent infections, the use of an antibiotic lotion such as clindamycin 1% applied to the area twice a day can help prevent recurrence.
5) Show and wash the tender areas everyday gently. Do not scrub with a washcloth, brush or loofah
6) Avoid smoking
7) Use antiperspirants rather than deodorants
8) Avoid exposure to hot, humid environments as much as possible
I hope that you have found this information useful. Wishing you the best of health,
Updated for 2026: There Are Real Drugs For This Now
When I wrote this in 2012, hidradenitis suppurativa was a condition I could describe far better than I could treat. There were no approved medications for it. Antibiotics, drainage, and surgery, and a lot of people cycling through all three for years. That has changed, and if you were told years ago that nothing much could be done, you were told something that was true then and is not true now. Three biologics now carry FDA approval for moderate to severe disease. Adalimumab, a TNF inhibitor, was first, approved in 2015. Secukinumab, which blocks interleukin 17A, was approved on October 31, 2023, dosed at 300 milligrams every four weeks with the option to move to every two weeks if the response is not enough (1). Bimekizumab, which blocks both IL-17A and IL-17F, followed on November 20, 2024, with phase 3 responses holding out to forty eight weeks (2). Two approvals in about a year, after a decade with one. That is the most movement this condition has seen in my career.Staging Still Drives the Decision
Hurley staging has not changed and it is still how severity gets sorted. Stage one is abscesses without tunnels or scarring. Stage two adds recurrent abscesses with sinus tracts and scarring. Stage three is diffuse involvement with multiple interconnected tunnels (3). The stage is what decides whether this is a topical and antibiotic conversation or a biologic conversation. It is worth knowing yours and asking for it by name.What This Looks Like Over Video, and Where It Does Not Work
I can do a fair amount here. History, how long, what triggers a flare, what has already been tried and how far each was pushed. The effect on your life, which in this condition is enormous and routinely under-asked. Photographs of known lesions over time are genuinely useful for tracking whether something is working. Where video runs out is staging and starting a biologic. Counting nodules and tunnels, and mapping how far the disease actually extends, needs hands and an in-person look. Starting a biologic also needs screening bloodwork first, tuberculosis testing and hepatitis serologies among them. That is a referral, not a video prescription, and I would be doing you a disservice to pretend otherwise. The most useful thing I can do from here is name it correctly and get you to a dermatologist, because the average person with this condition spends years being told they have recurrent boils.When To Be Seen Promptly
Fever, feeling systemically unwell, or redness spreading fast, which suggests infection beyond the usual flare. A lesion tense and painful enough to need draining. And any long standing wound in advanced disease that will not heal, changes character, or starts behaving differently, because squamous cell carcinoma arising in chronic hidradenitis is rare but real and is the reason nobody should be managing stage three alone.The Bottom Line
If your information about this condition is more than a few years old, it is out of date in a way that matters. Find out your Hurley stage, and if it is moderate or severe, ask specifically about biologics. This is no longer a condition where the honest answer is to keep draining them.Sources
1. Novartis. FDA approves Cosentyx (secukinumab) for hidradenitis suppurativa. October 31, 2023. https://www.novartis.com/news/media-releases/fda-approves-novartis-cosentyx-first-new-biologic-treatment-option-hidradenitis-suppurativa-patients-nearly-decade 2. UCB. FDA approval of Bimzelx (bimekizumab) for moderate to severe hidradenitis suppurativa. November 20, 2024. https://www.ucb.com/newsroom/press-releases/article/ucb-receives-us-fda-approval-for-bimzelxr-bimekizumab-bkzx-as-the-first-il-17a-and-il-17f-inhibitor-for-adults-with-moderate-to-severe-hidradenitis-suppurativa 3. American Academy of Dermatology. Hidradenitis suppurativa: diagnosis and treatment. https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-treatmentRelated Reading
Abscesses and MRSA: What To Do About a Skin Infection When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One Scott Rennie, D.O.Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
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Reblogged this on wjb1975.
Hi, I am a HS sufferer, going on 7 years now. Are you aware of any doctor here in the Honolulu area that specializes in this disease? I have tried so many different options.for.treatment during the past 4 years with no result. I am considering surgery now, but with most doctors I’ve seen not knowing much about the disease, I am desperately trying to find someone who is very knowledgeable and experienced in treating HS. Thanks for any info you can provide.
I’m just moving to the island, but I will keep a lookout for someone who specializes in that treatment. Aloha!
Thank you Doctor Rennie for sharing this useful information on hidradenitis, we could use more people from the medical profession sharing information from their practice about this condition. So often is is misdiagnosed and patients lose precious time in finding the proper treatment for managing it.
thanks its a useful information, but hence i want to shave n i know the cause is the friction when i shave so wot am i supposed to do o how am i suppose to shave with out using sharp object or anything which might cause friction, please do help with extra information
thank for your time
It might be a good idea to stop shaving for awhile and allow things to heal. You might also try using a different kind of shaver or non-razor solution.
All the best!
Dr Rennie, Can you recommend a doctor in Staten Island for my family member has this condition.
E-mail: jeanettebuss@yahoo.com
Hi Jeanette,
Not sure who to recommend in Staten Island as I live in Hawaii however I think most primary care providers could help with this condition.
I cannot thank you enough for your post. After being misdiagnosed, I looked under “lumps under arm” and recognized what could have been my arm on your post. I had other lumps, as well, and your description (as well as photo) caused me to research HS further. I’m reading a FABULOUS book (The Hidden Plague, by Tara Grant) and I’m no longer feeling like I’m an “unclean” person; there is hope for me, and you began my journey to my healing. I will forever be grateful.