The’hidradenitis suppurativa (HS), also called Hidradenitis suppurativa, is a chronic inflammatory skin condition that affects between 1 and 2% of the adult population in Canada [1]. However, it takes an average of 7 to 10 years old after the first symptoms appear [2]. Many people believe they are simply suffering from «recurrent boils» and are too embarrassed to seek medical attention. This article explains how to recognize HS, how it manifests in daily life, what treatments are available, and when it becomes important to seek medical advice in Quebec.
On this page
- What is hidradenitis suppurativa?
- What are the symptoms to recognize?
- What areas of the body are affected?
- How to assess severity with the Hurley stages?
- Why does the diagnosis take so long?
- What are the aggravating factors?
- What treatments are available?
- When to see a doctor?
- How to live with HS daily?
- Myths and misconceptions
- Frequently asked questions
- Sources
What is hidradenitis suppurativa?
The’hidradenitis suppurativa is a chronic inflammatory disease of Hair follicles (the hair follicle), mainly located in areas where skin rubs against skin or clothing. Contrary to what its old name («sweat gland disease») suggested, it is not caused by sweat glands or poor hygiene [1][3]. This is an immunological and inflammatory disorder whose cause is still only partially understood, with a recognized genetic component in about one-third of cases.
Key figures
- Prevalence : 1 to 2 out of every 3 adults in Canada [1]
- Average diagnostic time 7 to 10 years after the first symptoms [2]
- Female to male ratio approximately 3 women for every 1 man
- Typical age of onset after puberty, most often between 20 and 40 years old
- Family component : a family history found in approximately 30 to 40% of cases
Lesions typically appear after puberty and are more common in women of childbearing age. Smoking, obesity, and certain hormonal factors are aggravating factors documented by the Canadian Dermatology Association [3].
What are the symptoms to recognize?
Visit Symptoms of hidradenitis suppurativa evolve in flare-ups and often appear in the same place repeatedly. Recognizing the typical signs is essential to avoid confusing HS with simple boils or isolated cysts. The disease also leaves characteristic scarring.
Typical clinical signs
- Deep painful nodules that appear repeatedly in the same place
- Recurrent abscesses that sometimes spontaneously empty, releasing a purulent, often foul-smelling liquid
- Tunnels under the skin called Fistulas) that connect several lesions
- Cord scars in areas repeatedly affected
- Double-headed blackheads — two black dots adjacent to each other, characteristic of HS, almost pathognomonic
- Itching or burning often felt at the beginning of a flare-up
The Often Underestimated Impact
The pain, often sharp and throbbing, frequently disrupts Sleep, mobility, intimate life, and work. The psychological impact is significant: shame, isolation, anxiety, and depression are overrepresented among people with the condition, according to data from the International Hidradenitis Suppurativa Society [4]. Several studies have found that the quality of life of people with HS is among the most severely impaired of all dermatological conditions.
What areas of the body are affected?
HS preferentially affects areas where skin rubs against skin or clothing, and where apocrine hair follicles are concentrated. The most frequently affected areas are:
- Armpits (most frequent zone)
- Inguinal folds
- Under the breasts inframammary region
- Buttocks and perianal region
- Inner thighs
- More rarely: nape, scalp, abdomen and external genital region
The impairment may be unilateral or bilateral, whether limited to a single area or extending to multiple sites simultaneously. When the distribution is typical, it strongly influences the diagnosis.
How to assess severity with the Hurley stages?
Visit Hurley classification remains the most widely used tool for describing the severity of hidradenitis suppurativa and guiding treatment [3]. It classifies the disease into three stages based on the extent of the lesions and the presence of tunnels and scars.
Hurley's three stages
| Stadium | Description | Features |
|---|---|---|
| Stage I | Light form | Isolated, single, or multiple abscesses, without fistulas or scars |
| Stage II | Moderate form | Recurrent abscesses with tunneling (fistulae) and scarring, in one or more separate areas |
| Stage III | Severe form | Widespread damage to an area, multiple interconnected tunnels, extensive scarring |
The majority of diagnosed individuals are in the Stage I or II. Seeking early treatment can prevent the condition from progressing to more severe forms, which are harder to treat and result in more permanent scarring.
Why does the diagnosis take so long?
Visit average diagnostic delay of 7 to 10 years is one of the longest in the entire field of dermatology [2]. Several factors account for this delay, which unfortunately contributes to the progression of the disease before appropriate treatment is initiated.
The main causes of delay
- The first lesions are often confused with isolated boils, cysts, or acne
- Visit intimate localization (armpits, groin, buttocks) causes discomfort and delays consultation
- The HS is not always present during the medical examination, as the lesions evolve in flare-ups
- Several clinicians know little about the disease, especially on the front lines
- Affected individuals often try repeated self-medication before consulting
How to speed up diagnosis
- Bring to your doctor a Chronology of lesions in the last few months or years
- Take a few photos during flare-ups, especially if you're visiting during a quiet period
- Clarify the Recurring localization and the repetitive nature of the lesions
- Mention the presence of’Family history similar
- Report all Treatments already tried (antibiotics, drainages, etc.)
What are the aggravating factors?
Several factors are recognized for worsen hidradenitis suppurativa or trigger flare-ups. Some are modifiable and their management is an integral part of treatment.
Modifiable factors
- Smoking — the most important aggravating factor [3]
- Overweight and obesity — increase friction and inflammation
- Tight or synthetic clothing promote friction and maceration
- Irritant products (harsh soaps, spray deodorants)
- Shaving and hair removal in the affected areas (to be discussed with the doctor)
Non-modifiable or partial factors
- Genetic component — family history in 30 to 40% of cases
- Hormonal factors frequent premenstrual spotting
- Comorbidities associated conditions: metabolic syndrome, inflammatory bowel disease, arthritis
- Stress — can trigger or worsen flare-ups
To remember
- HS is affecting 1 to 2 out of every 3 adults in Canada
- The average diagnostic delay is 7 to 10 years old — you have to know how to recognize the signs
- Visit double-headed blackheads and tunnels beneath the skin are almost specific to the disease
- Visit smoking and obesity are the most important aggravating factors
- A Early support avoid progression to severe forms
- The’Psychological impact is significant and deserves to be taken into account
What treatments are available?
Visit Management of suppurative hidradenitis is based on a combination of treatments, tailored to the severity (Hurley stage) and the individual’s profile. There is no one-size-fits-all treatment for all cases—the strategy is always customized by the treating physician or dermatologist.
Lifestyle
- Smoking cessation — the most effective non-pharmacological measure
- Weight management when relevant
- Loose clothing and breathable fabrics to reduce friction
- Gentle hygiene with superfatted soaps or syndets, without irritants
- Warm compresses to relieve locally
Medical treatments
- Topical or oral antibiotics (clindamycin, tetracyclines, rifampin-clindamycin combination) to reduce inflammation and the bacterial component
- Hormone therapy in some women (combined contraceptives, spironolactone)
- Oral retinoids in select cases
- Biological : the’adalimumab was the first biologic approved by Health Canada for moderate to severe HS, followed more recently by secukinumab [5]
- Analgesics for pain management
Procedural and surgical approaches
- Corticosteroid injections in the inflammatory nodules
- Incision and drainage acute abscesses (does not eliminate the underlying lesion)
- Déroofing — surgical opening of the tunnel roof to allow for healing
- Excision large scarring in advanced stages
- Laser approaches (Nd:YAG, CO2) in certain specialized centers
Do you suspect you have hidradenitis suppurativa? Omicron Clinic offers quick access to a doctor for the evaluation of chronic skin conditions, the prescription of initial treatments, and referral to a dermatologist when necessary. Make an appointment or opt for a teleconsultation for an initial assessment.
When to see a doctor?
Signs that warrant a consultation
- Recurrent painful nodules in the armpits, groin, or buttocks for more than 6 months
- Recurring abscesses always in the same areas
- Purulent discharge frequent
- Cord scars tunnels under the skin
- Pain that disrupts your sleep, your work, or your social life
- Family history known from HS and appearance of nodules in typical areas
Warning Signs — Seek Medical Attention Promptly
- Fever associated with an inflammatory lesion (risk of severe infection)
- Widespread redness around the lesion with a sensation of intense heat
- Intense pain not responding to usual pain relievers
- Deterioration in overall health Chills, marked fatigue
- Heavy bleeding a wound that won't stop bleeding
A family physician can begin the evaluation, prescribe initial treatments, and refer the patient to a dermatologist when appropriate. In Quebec, wait times for public dermatology care can be long; private medical services often provide faster access to an evaluation and structured follow-up care.
How to live with HS daily?
The HS is a chronic disease : It is rare to make a full recovery, but with proper treatment, most people are able to reduce flare-ups, better manage pain, and regain a satisfactory quality of life. Regular follow-up—ideally with the same clinician—is a key factor in long-term disease control.
Useful everyday strategies
- Keep a journal of flares to identify personal triggers
- Prefer loose-fitting clothing in cotton or breathable technical fabrics
- Avoid aggressive shaving in the affected areas
- Use appropriate bandages for flowable materials (alginates, hydrocolloids)
- Maintain physical activity adapted for weight and stress management
- Take care of your mental health psychological support has its place
Support and resources
Feelings of isolation are common among people with HS, and there are several resources available in Quebec and across Canada: online support groups, patient organizations, and clinical support from a psychologist when needed. Don’t hesitate to talk to your doctor about this when the emotional impact becomes overwhelming.
Myths and misconceptions
«HS is caused by poor hygiene.»
False. HS has nothing to do with personal hygiene. It is an inflammatory and immunological disorder of the hair follicles. In fact, overly aggressive hygiene practices using irritating products can worsen the condition.
«It's contagious.»
False. Suppurative hidradenitis is not contagious. It cannot be transmitted through direct contact, sharing clothing, or using the same bathroom facilities.
«Antibiotics will cure the disease»
Nuanced. Antibiotics play an important role in reducing inflammation and the bacterial component during flare-ups, but they do not cure HS. A combined approach (lifestyle changes, medication, and sometimes surgery) is generally necessary for long-term management.
«You just need to drain each abscess, and everything will be fine.»
False. Incision and drainage quickly relieve the acute pain of an abscess, but do not eliminate the underlying lesion. Recurrence is almost inevitable. Underlying treatment is essential to alter the course of the disease.
Frequently asked questions
Can hidradenitis suppurativa be completely cured?
HS is a chronic disease, and a complete cure is rare. However, with appropriate management, most people can control flare-ups, reduce pain, and regain a satisfactory quality of life. Some people experience prolonged periods of remission, especially if they quit smoking and lose weight when appropriate.
Can my child develop hidradenitis suppurativa?
HS usually appears after puberty, so prepubertal children are rarely affected. However, when there is a significant family history of the condition, it may appear during adolescence. Any recurrent lesions in the typical areas in an adolescent warrant medical evaluation.
Does quitting smoking really make a difference?
Yes, smoking is the best-documented risk factor for HS. Quitting smoking can significantly reduce the frequency and severity of flare-ups in many people. It is often the first recommendation dermatologists make, even before prescribing medication.
Does HS increase the risk of other diseases?
Several comorbidities are associated with HS: metabolic syndrome, type 2 diabetes, inflammatory bowel diseases (Crohn’s disease, ulcerative colitis), spondyloarthropathies, and certain psychological disorders (anxiety, depression). Comprehensive medical follow-up is recommended to screen for and manage these associated conditions.
Are biologics reimbursed in Quebec?
Adalimumab is listed on Quebec’s drug formulary for the treatment of moderate-to-severe psoriasis, under specific clinical conditions and following failure of first-line treatments. Requests are generally submitted through a dermatologist or a specialist. Secukinumab was more recently evaluated by INESSS for this indication.
Sources
- Canadian Dermatology Association. Hidradenitis suppurativa — patient information.
- International Society for Supurative Hidradenitis. Clinical recommendations and diagnostic timeline.
- Canadian Dermatology Association. Hurley Classification and Aggravating Factors.
- Hidradenitis Suppurativa Foundation. Quality of life and psychosocial impact.
- Health Canada. Product Monographs — adalimumab and secukinumab.
- INESSS — National Institute for Excellence in Health and Social Services. Review of biologics in dermatology.
- Collège des médecins du Québec. Best Practices in General Dermatology.
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