Overview

Hidradenitis suppurativa (HS) is a chronic painful inflammatory skin condition causing lumps, abscesses, and scarring in skin fold areas — armpits, groin, buttocks, under breasts. Not caused by poor hygiene and not contagious. It is autoimmune-related and frequently misdiagnosed as boils or acne.

Symptoms

• Painful pea-sized lumps that may enlarge into abscesses
• Sinus tracts (tunnels) under the skin; rope-like scarring
• Double-barrel comedones (blackhead pairs) — a hallmark diagnostic sign
• Drainage of bloody or foul-smelling fluid

Causes & Risk Factors

• Blocked hair follicles in apocrine sweat gland areas; immune system dysfunction
• Genetic predisposition (family history in 40%); hormonal influences
• Obesity and friction (relevant in Kuwait's heat); smoking strongly associated

Complications

• Permanent scarring; restricted joint movement; lymphedema
• Squamous cell carcinoma — rare but serious in long-standing disease
• Depression, social isolation; associated with Crohn's disease and metabolic syndrome

Diagnosis

Clinical: recurrent abscesses in characteristic locations, double-barrel comedones, sinus tracts. Severity graded by Hurley Stages I-III.

Treatment

• Topical clindamycin for mild disease; oral antibiotics (tetracyclines, clindamycin + rifampicin)
• Biologic: adalimumab (Humira) — FDA/EMA-approved for HS; secukinumab recently approved
• Surgery: deroofing or wide excision for advanced disease
• Lifestyle: weight loss and smoking cessation significantly improve outcomes

Prevention

• Maintain healthy weight and quit smoking
• Wear loose breathable clothing — especially important in Kuwait's heat
• Keep skin folds clean and dry; use laser hair removal instead of shaving affected areas

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