Hidradenitis suppurativa: symptoms and treatment in Quebec

L’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 appearance of the first symptoms [2]. Many people think they are suffering from simple «recurring boils» and hesitate to consult due to embarrassment. 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?

L’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 a lack of hygiene This is an immunological and inflammatory disorder whose origin is still partially understood, with a genetic component recognized 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

The lesions typically appear after puberty and affect women of childbearing age more often. Smoking, obesity, and certain hormonal factors are documented aggravating factors by the Canadian Association of Dermatology [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 in affected individuals, according to data from the International Hidradenitis Suppurativa Foundation [4]. Several studies rate the quality of life for people with HS as among the most impaired of all dermatological diseases.

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 involvement can be unilateral or bilateral, ..., limited to a single area or extended to multiple sites simultaneously. The distribution strongly guides the diagnosis when it is typical.

How to assess severity with the Hurley stages?

Visit Hurley classification remains the most used tool to describe the severity of hidradenitis suppurativa and guide treatment [3]. It classifies the disease into three stages according to the extent of lesions, 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	Diffuse involvement of an area, multiple interconnected tunnels, extensive scarring

The majority of diagnosed individuals are in the Stage I or II. Early consultation helps prevent progression to more severe forms, which are harder to treat and leave 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 all of dermatology [2]. Several factors explain this delay, which unfortunately contributes to the worsening 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 lull
• 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: 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
• L’Psychological impact is major and deserves to be taken into account

What treatments are available?

Visit Hidradenitis suppurativa management is based on a combination of treatments, adapted to the severity (Hurley stage) and individual profile. No universal treatment applies to all cases — the strategy is always personalized 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, rifampicin-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 underlying lesion)
• Déroofing — surgical opening of a tunnel roof to allow healing
• Excision large scarring in advanced stages
• Laser approaches (Nd:YAG, CO2) in certain specialized centers

Do you suspect you have hidradenitis suppurativa? Clinique Omicron offers quick access to a doctor for the evaluation of chronic skin lesions, prescribing 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 over 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

Alarm signs — consult immediately

• 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
• Change in general condition Chills, marked fatigue
• Heavy bleeding of a lesion that doesn't stop

A family doctor can initiate the assessment, prescribe initial treatments, and refer to a dermatologist when appropriate. In Quebec, the waiting time for public dermatology can be long; private medical services often allow faster access to an assessment and structured follow-up.

How to live with HS daily?

The HS is a chronic disease it is rare to be completely cured, but good management allows the majority of people 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

The feeling of isolation is common among people with HS, and several resources exist in Quebec and Canada: online support groups, patient associations, and clinical support from a psychologist when necessary. Do not hesitate to discuss it with your doctor when the emotional impact becomes heavy.

Myths and misconceptions

«HS is caused by a lack of hygiene.»

False. HS has no link to personal hygiene. It is an inflammatory and immunological disorder of the hair follicles. On the contrary, over-aggressive hygiene with irritating products can worsen the condition.

«It's contagious»

False. Hidradenitis suppurativa is not contagious. It cannot be transmitted through direct contact, sharing clothes, or using the same sanitary 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, medication, sometimes surgery) is generally necessary for long-term control.

«You just need to drain each abscess, and everything will be fine.»

False. Incision and drainage provide rapid relief for the acute pain of an abscess but do not eliminate the underlying lesion. Recurrence is almost systematic. Underlying treatment is essential to modify the course of the disease.

Frequently asked questions

Can hidradenitis suppurativa be completely cured?

HS is a chronic disease and complete recovery is rare. However, appropriate management allows most people to control flares, reduce pain, and regain a satisfactory quality of life. Some individuals experience prolonged periods of remission, especially if they quit smoking and lose weight when relevant.

Can my child develop hidradenitis suppurativa?

HS usually appears after puberty, so prepubescent children are rarely affected. However, when there is a significant family history, onset in adolescence is possible. Any recurrent lesion in typical areas in an adolescent warrants medical evaluation.

Does quitting smoking really make a difference?

Yes, smoking is the best-documented exacerbating factor of HS. Quitting smoking can significantly reduce the frequency and intensity of flares in many people. It is often the first recommendation from dermatologists, 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 formularies for the treatment of moderate to severe hidradenitis suppurativa, under specific clinical conditions and after failure of first-line treatments. Requests are typically made by a dermatologist or a specialist physician. Secukinumab was more recently evaluated by INESSS for this indication.

Sources

1. Canadian Dermatology Association. Hidradenitis suppurativa — patient information.
2. International Hidradenitis Suppurativa Foundation. Clinical recommendations and diagnostic timeline.
3. Canadian Dermatology Association. Hurley Classification and Aggravating Factors.
4. Hidradenitis Suppurativa Foundation. Quality of life and psychosocial impact.
5. Health Canada. Product Monographs — adalimumab and secukinumab.
6. INESSS — National Institute of Excellence in Health and Social Services. Review of biologics in dermatology.
7. Collège des médecins du Québec. Best Practices in General Dermatology.

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