The Hidden Challenges of Hidradenitis Suppurativa, with Jennifer Hsiao, M.D.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that often presents as boil-like nodules or abscesses and typically appears in skin folds like the armpits, groin or buttocks, though it can also occur elsewhere. The condition can be detected even during routine skin checks, underscoring the need for public awareness and early diagnosis to improve patient outcomes.

In an interview with The Educated Patient, Jennifer Hsiao, M.D., a dermatologist and clinical associate professor of dermatology at the University of Southern California, emphasizes that HS's hallmark is recurrent nodules and boils, which should alert both patients and providers to look beyond a simple staph infection. Contrary to earlier beliefs, HS affects about 0.1% to 1% of the population, or roughly one in 100 people, making it more common than previously thought.

In the United States, women are disproportionately affected by HS, with a female-to-male ratio of more than 2-to-1, though Hsiao notes that this trend is reversed in some countries including Japan. She stresses that anyone, regardless of gender or race, can develop HS, and that early symptoms include recurrent bumps in skin folds and sometimes blackheads in these areas. However, diagnosis is often delayed — by an average of 10 years — due to a lack of public awareness, limited provider knowledge and the embarrassing nature of the symptoms, which can occur in private areas.

Hsiao explains that this delay can lead to severe impacts on daily life and an increased risk of depression and anxiety. While HS has no cure, treatments — such as adalimumab and secukinumab — aim to reduce flare-ups and improve quality of life. Effective management can make flares less frequent, smaller and easier to handle, allowing patients to maintain daily activities.

Hsiao stresses the importance of timely access to advanced therapies, aiming to intervene before significant tissue damage and scarring occur, which might require both medication and surgery. She urges patients to partner with healthcare providers to find the right treatment, as multiple therapies may be needed.

She also highlights resources like the HS Foundation and various support groups, including Hope for HS, HS Connect and the International Association of the HS Network, which provide information and peer support, helping patients connect and feel empowered to manage their condition.