Hidradenitis suppurativa (HS) is a painful, distressing, and often misunderstood skin condition that causes recurrent boils, abscesses, and scarring, typically in the armpits, groin, buttocks, and under the breasts. Many patients live with HS for years before receiving an accurate diagnosis, often having been treated repeatedly with antibiotics that offer only temporary relief.

 

Dr Bryan McDonald is a Consultant Dermatologist in London with specialist experience in the diagnosis and long-term management of hidradenitis suppurativa, offering both medical and procedural treatment options tailored to the severity of your condition.

 

What is hidradenitis suppurativa?

HS is a chronic inflammatory skin condition affecting hair follicles in areas where skin rubs together. It is not an infection and it is not contagious. HS causes deep, painful nodules that can rupture, leak, and form tunnels under the skin (sinus tracts), leading to permanent scarring if not properly managed.

 

Symptoms of HS

• Recurrent painful boils in the groin, armpits, buttocks, or under breasts

• Abscesses that burst and leak fluid

• Persistent scarring and skin thickening

• Tunnels under the skin

• Flares that return in the same areas

 

Why HS is often misdiagnosed

HS is frequently mistaken for:

• Recurrent infected cysts

• Ingrown hairs

• Simple boils

• Poor hygiene (which it is not)

Correct diagnosis is essential because HS requires a completely different treatment approach from standard antibiotics.

 

When should you see a dermatologist?

You should see a specialist if:

• You have recurrent boils in the same areas

• Antibiotics only help temporarily

• You are developing scarring

• The condition is affecting your quality of life

 

How I diagnose HS

Diagnosis is clinical and based on:

• Distribution of lesions

• Recurrence pattern

• Presence of scarring or sinus tracts

• Assessment of severity using Hurley staging (which guides treatment)

 

Treatment options I offer

HS requires a long-term management plan. Treatment may include:

• Longer courses of antibiotics

• Targeted anti-inflammatory medications

• Hormonal treatments where appropriate

• Steroid injections into active nodules

• Advanced systemic therapies

• Surgical options for persistent areas

• Lifestyle guidance (weight, smoking, friction reduction)

The aim is not just to treat flares but to prevent progression and scarring.

 

What to expect at your consultation

Your appointment will include:

• Detailed history of your HS journey

• Skin examination

• Discussion of previous treatments

• Creation of a personalised management plan

 

FAQs

1. Is HS contagious?
No.

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2. Why do antibiotics keep failing?
Because HS is inflammatory, not infectious.

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3. Will I need surgery?
Some patients benefit from minor surgical procedures for persistent areas.

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4. Can HS be cured?
HS is chronic, but with the right treatment it can be controlled very effectively.

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5. What lifestyle changes help?
Weight management, smoking cessation, and friction reduction can reduce flares.

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Book a consultation

If you are struggling with hidradenitis suppurativa, you can book a consultation with Dr Bryan McDonald, Consultant Dermatologist in London, for a detailed assessment and personalised treatment plan.