Hidradenitis Suppurativa (HS) is a chronic, debilitating inflammatory skin disease causing recurrent boil-like lesions, pustules, abscesses, and wounds. HS can occur almost anywhere on the body, but most typically affecting the axillae, groin, perianal region, buttocks and genitals. Onset usually occurs in early adulthood. HS lesions are painful, malodorous and exude purulent discharge, having a severe impact on quality of life.
Prevalence and Diagnostic Delay
HS affects an estimated 1% of the population. Patients experience a diagnostic delay of 7–10 years and symptoms often worsen, forming sinus tracts and recurrent abscesses. Patients often seek over-the-counter solutions, making pharmacists well positioned to recognise HS early.
Misdiagnosis
HS is commonly misdiagnosed as skin infections, ingrown hairs or sexually transmitted infections. HS is inflammatory and typically contains non-pathogenic bacteria, although secondary infections can occur. Many patients are wrongly told HS is caused by poor hygiene, contributing to stigma and mistrust.
Recognising HS
If the patient has had two or more outbreaks of boils in typical HS areas in the last six months, HS can be diagnosed with >90% specificity.
Clinical clues include repeated requests for “boil” treatments, wound dressings, frequent antibiotic prescriptions, and pain-relief.
HS severity is graded using the Hurley Staging System:
Stage I isolated lesions without sinus tracts
Stage II recurrent lesions with sinus tract formation
Stage III widespread interconnected tracts with minimal healthy skin
Treatment and Wound Care
Treatment includes topical clindamycin, oral tetracyclines, clindamycin & rifampicin, corticosteroids, biologics (adalimumab, infliximab, bimekizumab), hormonal therapies and surgery.
Effective wound care includes soft, non-irritating dressings, super-absorbents for heavy exudate, adhesive-free options, and good hygiene. Warm compresses can help lesions drain, while cold packs can reduce pain. HS specific wound-care options are available on prescription.
Lifestyle, Mental Health and Support
Smoking cessation, weight management and psychological support are important, as HS is strongly linked with anxiety, depression and social withdrawal. Support and resources for patients are available at HS Ireland (www.hsireland.ie)
How Pharmacists Can Help
Pharmacists can:
• recognise HS early and refer appropriately
• provide empathetic, private consultations
• advise on complex treatments, pain/itch management, wound care, smoking cessation and weight loss
• display HS information
Conclusion
HS is not rare. Pharmacists are most likely encountering these patients, and can play a crucial role in early recognition, reducing diagnostic delays, improving outcomes and supporting long-term patient wellbeing.