What is hidradenitis suppurativa (HS) — and what actually helps?
Hidradenitis suppurativa is one of the most under-diagnosed and most isolating conditions I see. Painful lumps in the armpits, groin, under the breasts — recurring, draining, scarring. Patients often spend years being told they have boils, poor hygiene, or bad luck, and many stop seeking care entirely out of embarrassment. In two decades of practicing medicine, few things frustrate me more, because HS is a recognized inflammatory disease with real treatment. Let’s start there.
First, what HS is not
It is not an infection, and it is not caused by being unclean. HS is a chronic inflammatory disease of the hair follicle — even the old idea that it’s a sweat-gland disorder turned out to be wrong. Here’s the actual sequence: the opening of a hair follicle plugs up, the follicle swells and eventually ruptures, and its contents spill into the surrounding skin. Your immune system reacts to that spill with a powerful inflammatory response, and when it happens over and over, that inflammation builds abscesses, tunnels under the skin, and scarring. Understanding this changes everything about how HS gets treated — you can’t antibiotic your way out of an immune-driven disease.
The medical treatment you deserve access to
Dermatology guidelines grade the options, and one biologic medication — adalimumab — carries the highest grade of evidence in HS, with several other biologics and targeted agents behind it. Certain antibiotic combinations, retinoids, and hormonal treatments each have their place depending on severity. Surgical options matter for established tunnels. Everything I describe below is an adjunct to that care, not a substitute — and if your HS is moderate or severe and no one has discussed these options with you, that’s a gap worth closing.
The lifestyle piece is recommended at every stage
This is unusual and worth noting: lifestyle modification is recommended at every severity level of HS, not just mild disease. Weight reduction leads — it’s associated with reduced HS severity, with the strongest effect in patients with significant weight to lose, and it also addresses the metabolic conditions that travel with HS. That’s a direct connection to our physician-supervised weight loss program, and for an HS patient it isn’t cosmetic — it’s part of treating the disease. Friction matters too: looser clothing, gentler pH-balanced cleansers, and avoiding anything that rubs the affected areas. Alcohol and poor sleep both track with worse severity. Smoking cessation is recommended primarily for the serious comorbidity risk that accompanies HS.
Diet and supplements, honestly graded
The evidence here is positive but weak, and I’ll label it that way. A Mediterranean-style pattern that minimizes sugar, refined carbohydrates, and dairy while emphasizing vegetables, fruit, poultry, and fish has supportive data (our Mediterranean diet page has the practical version). Zinc and vitamin D both have supportive though weak evidence, and omega-3s have a plausible anti-inflammatory rationale. Patients also commonly try turmeric, magnesium baths, and CBD — reported benefit varies widely and robust evidence is lacking, though harm appears uncommon. Where labs show a genuine deficiency, we replace it properly, individualized and provided through our office rather than guessed at.
The hormone and metabolic angle most patients never hear
HS is influenced by androgens, which is why hormonal treatments appear in the guidelines at all, and why flares often track with menstrual cycles. It also clusters with metabolic disease and insulin resistance — metformin shows up in HS guidelines for exactly that reason. This is where our work fits naturally: comprehensive labs including hormones and metabolic markers, an honest look at insulin resistance and weight, and treatment of the whole system driving the inflammation. For treatment-resistant inflammatory skin disease, low-dose naltrexone also has a small dermatology literature worth discussing openly.
You don’t have to manage this alone
HS carries a heavy psychological burden — pain, drainage, odor, and visible scarring in private places lead a lot of people to withdraw. That burden is part of the disease and deserves treatment too. Measure, don’t guess: labs, an honest severity assessment, coordination with dermatology for the medical and surgical care you need, and the metabolic and hormonal work we do best. Come in and be treated like a patient with a real disease — because that’s what you are. Start with the fundamentals on our lifestyle page.
Text us at 480-485-2197 to schedule, or call. Quick response, real scheduling, no phone tree.
To Health and Wellness,
Dr. Tallman
References
- Lancet, 2025 — hidradenitis suppurativa, comprehensive review
- Journal of the American Academy of Dermatology, 2019 — North American clinical management guidelines for hidradenitis suppurativa
- American Journal of Clinical Dermatology, 2023 — effects of exercise and dietary modifications on hidradenitis suppurativa
- JAMA Dermatology, 2025 — efficacy and safety of medical interventions for moderate-to-severe hidradenitis suppurativa
- JAMA Dermatology, 2020 — complementary and alternative medicine use in patients with hidradenitis suppurativa
- JAMA, 2017 — hidradenitis suppurativa, clinical review