Hidradenitis Suppurativa in Women

Hidradenitis suppurativa causes large, red bumps to form around hair follicles, most commonly on the buttocks, breasts, groin, armpits or inner thighs. Symptoms can range from mild to severe, affecting one or multiple areas of the body at a time.

With hidradenitis suppurativa, bumps can become deeply embedded under the skin. Commonly mistaken for boils, these bumps can be painful. The bumps gradually get larger and drain pus, which can cause an odor. Recurrent flare-ups are common and can last for days or months.

Complications of HS may include:

• Scarring
• Restricted limb mobility
• Strictures or fistulas at the anus and urethra from chronic inflammation
• Disfigurement
• Squamous cell carcinoma (very rarely)

Although triggers can vary from person to person, women commonly experience flare-ups with major hormonal changes, including:

• During menstruation
• During pregnancy
• After pregnancy (postpartum)

Non-hormonal HS triggers may include:

• Diet
• Heat
• Stress
• Sweating
• Tightly fitted clothing
• Tobacco use
• Weight gain

While the exact cause of hidradenitis suppurativa is unknown, several factors may play a role, including genetics, hormones and obesity.

HS is not caused by poor hygiene, sexually transmitted infection or other infections. (It is not contagious.)

Common underlying risk factors include:

• Arthritis
• Diabetes
• Inflammatory bowel disease (IBD)
• Metabolic syndrome
• Obesity
• Polycystic ovarian syndrome (PCOS)

It’s believed that hormones could play some role in hidradenitis suppurativa, considering that:

• HS affects more women than men.
• HS is most common in women between puberty and menopause.
• Many women experience HS flare-ups with hormonal changes, such as during the menstrual cycle and pregnancy.
• In some women, birth control pills (hormone therapy) can help manage HS symptoms.

However, we do not know the exact mechanism by which hormones play a role in causing hidradenitis suppurativa.

To avoid worsening your symptoms, it is best not to shave during hidradenitis suppurativa flare-ups. Talk with your dermatologist about other options for hair removal. 

Flare-ups on or under the breast can make breastfeeding more difficult, but most women are able to breastfeed with hidradenitis suppurativa. If you’re pregnant and you plan to breastfeed, have an early discussion with your dermatologist to learn what steps you can take before delivery to help manage or avoid HS flare-ups. Early intervention is key.