Hidradenitis Suppurativa: Causes, Symptoms & Treatment Options in Canada

Recurring painful lumps, abscesses, drainage, and scarring can make everyday activities uncomfortable and emotionally exhausting. Hidradenitis Suppurativa is a chronic condition that often goes undiagnosed for years. Understanding its causes, warning signs, and treatment options can help access on-time care, reduce flare-ups, and improve quality of life.

Key Takeaways

• Hidradenitis Suppurativa (HS) is a chronic inflammatory condition affecting hair follicles, not a hygiene-related issue.
• Early symptoms include burning, itching, swelling, and painful nodules in friction-prone areas.
• Treatment varies by severity and may include topical therapies, medications, biologics, or surgery.
• Early diagnosis helps prevent scarring, tunnels, mobility limitations, and long-term complications.

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease characterized by deep-seated nodules, abscesses, and sinus tunnels in the groin or armpits. Although it used to be referred to as acne inversa, it is not standard acne and is not related to cleanliness or hygiene. HS is a disorder of the immune system and hair follicles, and it is completely non-contagious in nature.

So, what causes it? What are the symptoms of Hidradenitis Suppurativa? How can it be treated? Let’s find all the answers here.

What Causes Hidradenitis Suppurativa?

Research published by Value in Health suggests that 3.84% of the population experiences Hidradenitis Suppurativa in Canada. 1.49% were identified through self-reported cases, and 2.36% were from diagnosed cases.

So, what are the key causes of Hidradenitis Suppurativa? What are the triggers and risk factors? Let’s find out.

Reasons Behind Hidradenitis Suppurativa

Here are the key reasons behind Hidradenitis Suppurativa.

• Follicle blockage, especially in areas like the groin, armpits, and buttocks, where skin rubs together.
• Following the rupture of blocked follicles, the immune system overreacts and results in nodules, tunnels under the skin, and inflammation.

Risk Factors and Triggers

Here are the primary risk factors and triggers that influence HS.

• The issues regarding HS often begin after puberty, and women are 3 times more susceptible to this than men.  
• HS is often inherited. Up to 1/3 of people who experience HS have a family history of this issue.
• Smoking is a common environmental trigger of HS.
• Metabolic changes and excess weight cause inflammation and increase skin-on-skin friction.

Note: Research suggests that cardiovascular and metabolic comorbidities are highly associated with hidradenitis. The comorbidity issues also involve gastrointestinal, rheumatologic, and psychiatric challenges.

What are the Symptoms of Hidradenitis Suppurativa?

The symptoms of hidradenitis suppurativa include recurring boil-like abscesses, painful and deep-seated nodules, and progressive scarring. So, since we have answers to what causes hidradenitis suppurativa, let’s take a look at the primary and advanced symptoms of suppurativa.

Early Prodromal Symptoms

So,  12-48 hours before the lesion appears, individuals may experience some major warning signs. Here are the common signs you should be aware of:

• Burning sensations
• Itching or stinging
• Hyperhidrosis or excessive sweating
• Swelling

Primary Skin Lesions

As hidradenitis develops, you will experience the following changes on the skin:

• Painful nodules (0.5 to 2 cm in size), persisting for weeks or months.
• Pus-filled abscesses, highly inflamed nodules that rupture eventually.
• Foul-smelling discharge of a mixture of purulent fluid and blood (serosanguinous).
• Small, paired blackhead-like spots.

Advanced and Progressive Symptoms

If HS is not addressed at the early stage, the chronic inflammation alters the deeper tissue and affects patients’ well-being on a significant scale. Here’s what it leads to.

• Sinus tracts (tunnels)
• Chronic leaking
• Severe scarring
• Restricted mobility

Note 1: The advanced stage of hidradenitis may also lead to plaques and fibrotic scars, which cause open or tombstone comedones. 

Note 2: The less common sites of HS include the abdomen, the back of the neck, and the chest. Moreover, the symptoms also include fatigue, emotional distress, and depression.

So, before it becomes a major threat, get the best guidance and medical support from Clini Derma to stay active and hassle-free

How is Hidradenitis Suppurativa Treated? A Canada-focused Overview

Check our detailed discussion on how to treat hidradenitis suppurativa here.

Hurley Staging System

Following the appearance of lesions, they are categorized in the Hurley Staging System. The table below briefly identifies different stages.

Stages	Description
Hurley Stage I	Abscesses lack scars and tunnels.
Hurley Stage II	Scars and tunnels in recurrent abscesses.Widely separated lesions (single or multiple)
Hurley Stage III	Diffused lesions in the skin.Abscesses on large areas.Presence of multiple interconnected sinuses.

Table: Hurley Staging System

Note: Apart from the Hurley Staging System, dermatologists also use the visual analog scale (VAS) and the dermatology life quality index (DLQI) to assess how hidradenitis affects patients’ everyday activities.

Topical and Local Treatments

In cases of Hurley Stage I, dermatologists suggest localized therapies to clear clogged follicles and reduce inflammation.

• Antibiotics (e.g., clindamycin, in forms of gel or lotion).
• Corticosteroid injections (e.g., triamcinolone).
• Resorcinol creams.
• Antiseptic and antiperspirant agents, such as, 6.25% aluminum chloride hexahydrate in absolute ethanol.

Oral Medications & Systemic Therapies

For recurring or moderate HS, experts prescribe systemic drugs, such as oral antibiotics, biologics, and hormonal therapies.

• Doxycycline or a combination of clindamycin and rifampin (anti-inflammation).
• Adalimumab, an FDA-approved injectable medication.
• Spironolactone (an anti-androgen medication) is prescribed for women of childbearing age. (15-49), but only if the issues are mild.
• Retinoids like isotretinoin (results may vary).

Procedures and Surgery

For the stage III HS issue, experts suggest surgery to treat scarring and recurring abscesses, ensuring long-term relief.

• Removing the roof of an abscess or a sinus tract to prevent lumps (deroofing).
• Surgical excision of the affected tissue and skin, followed by a skin graft.
• Neodymium:yttrium-aluminium-garnet (Nd:YAG) laser therapy to destroy hair follicles, preventing new hidradenitis lesions.

Lifestyle and Home Management

Professionals often prioritize lifestyle management to prevent Hidradenitis Suppurativa in Canada.

• Smoking cessation
• Weight management
• Wound care and hygiene.
• Antiseptic skincare
• Dietary management
• Loose clothing

Why does Early Diagnosis Matter? When Should You Visit a Dermatologist?

Research shows that patients with Hidradenitis Suppurativa in Canada experience a waiting time of 7 years before they receive an accurate diagnosis.

Visit Clini Derma to avoid this delay, as we offer real-time and proper HS management. The team at Clini Derma in Laval, Montreal, and the West Island specialises in HS diagnosis and personalized, guideline-aligned treatment planning.

If you notice recurring painful lumps or lesions that are spreading across multiple body areas, seek specialist intervention and support from Dr. Joseph Doumit. Do not delay, as these symptoms indicate stage II HS or beyond.

Wrapping Up

Hidradenitis Suppurativa is more than a skin condition as it significantly affects physical comfort, mobility, and emotional well-being. Early recognition and personalized treatment are essential to tackle its progression and prevent complications. With medical guidance, lifestyle adjustments, and appropriate therapies, many patients can effectively manage symptoms and enjoy a better quality of life.

Frequently Asked Questions