Hidradenitis suppurativa — known in medical literature as HS or acne inversa — is one of the most under-diagnosed and poorly understood chronic skin conditions of our time. Affecting approximately 1% of the global population, it causes painful nodules, abscesses, and sinus tracts in areas where skin surfaces meet, including the armpits, groin, perianal region, and beneath the breasts. Yet despite its prevalence and devastating impact on quality of life, many patients spend years without a correct diagnosis.

The good news is that 2024 and 2025 have brought a landmark revision to how the medical community classifies, evaluates, and treats HS. Both the European Academy of Dermatology and Venereology (EADV) and the North American Hidradenitis Suppurativa Foundation have issued updated guidelines that completely overhaul prior thinking — incorporating newly approved biologics, refined surgical approaches, and critical guidance for special patient populations.

What is Hidradenitis Suppurativa?

HS is a chronic, recurrent inflammatory disease of intertriginous skin — those body areas where two skin surfaces touch and create friction. It involves the apocrine sweat glands and hair follicles, beginning typically as a deep folliculitis that expands over time. The armpits, inner thighs, groin, buttocks, and perineum are most commonly affected.

The causes are not fully known, but several factors are implicated: bacterial infections (staphylococci or streptococci), trapped sweat in hair follicles, hormonal changes, smoking, and obesity. Crucially, HS is not contagious, nor is it caused by poor hygiene — a misconception that causes significant psychological harm to patients.

How HS is Classified Today

The 2025 European S2k Guidelines introduced a dual classification system that replaces the older one-dimensional approach. Clinicians now distinguish between:

The Inflammatory Form: Graded as mild, moderate, or severe using the IHS4 (International Hidradenitis Suppurativa Severity Score System) — a validated tool that counts nodules, abscesses, and draining tunnels to produce a numeric score guiding treatment intensity.

The Predominantly Non-Inflammatory Form: Assessed using the classic Hurley Staging System (Stages I, II, and III), which evaluates the extent of scarring, sinus tract formation, and skin destruction — particularly relevant for surgical planning.

The 2024–2025 Treatment Algorithm

The most significant development in the updated guidelines is the tiered, multimodal treatment algorithm — matching therapeutic intensity to disease severity, and emphasising a combination of medical and surgical approaches as the gold standard of holistic care.

STAGE-BY-STAGE TREATMENT APPROACH

NEWLY APPROVED BIOLOGICS

Perhaps the most clinically impactful development in recent years is the approval of two new biologic agents for moderate-to-severe HS, adding to the existing armamentarium of adalimumab (approved since 2015):

• Secukinumab — an IL-17A inhibitor that demonstrated strong efficacy and safety in real-world settings for moderate-to-severe HS.
• Bimekizumab — a dual IL-17A/IL-17F inhibitor showing significant results in the landmark BE HEARD I and BE HEARD II Phase 3 trials (The Lancet, 2024), with rapid onset and sustained disease control.

These approvals mean clinicians now have three distinct biologic pathways — each with different mechanisms of action — to offer patients who do not respond to initial medical management.

THE SURGICAL DIMENSION

The updated guidelines firmly establish that surgery is not a last resort — it is a core component of comprehensive HS care. While biologics and systemic therapies control active inflammation, they cannot reverse the scarring, sinus tract formation, and irreversible tissue destruction that severe HS causes. The combination of ongoing medical therapy with well-timed surgical intervention is now recognised as the most effective holistic approach.

Surgical techniques range from incision and drainage (for acute abscesses) and deroofing of sinus tracts, to wide local excision in advanced Hurley Stage III disease. At specialised centres, advanced laser techniques have emerged as a minimally invasive, high-precision alternative — offering near-painless procedures with rapid recovery.

LIFESTYLE MODIFICATIONS & COMORBIDITY SCREENING

Comprehensive care includes screening for metabolic syndrome, diabetes, hypertension, depression, anxiety, inflammatory bowel disease, and inflammatory arthropathy — all of which occur at elevated rates in HS patients. Weight loss, smoking cessation, and avoiding tight clothing are key lifestyle interventions that significantly modify disease course.

SPECIAL PATIENT POPULATIONS

For the first time, dedicated North American clinical guidelines now exist for HS management in seven special populations: pregnancy, breastfeeding, paediatrics, active malignancy, tuberculosis infection, hepatitis B or C infection, and HIV disease — filling a critical gap in evidence-based care for patients frequently excluded from clinical trials.

· · ·

Expert hidradenitis suppurativa Care in Delhi NCR: Mirascare Clinic

For patients across Delhi, Gurgaon, and the wider NCR region, accessing a surgeon with specialised expertise in hidradenitis suppurativa — and equipped with the latest laser technology — has historically been a challenge. Mirascare Multispeciality Clinic, founded and led by Dr. Mir Asif Rehman, has changed that equation.

About Dr. Mir Asif Rehman

HIDRADENITIS SUPPURATIVA LASER TREATMENT AT MIRASCARE

For HS patients, Mirascare offers one of the most advanced laser surgical pathways available in North India. Using the 1470 nm diode laser system at 15W — the same technology used in leading international centres — Dr. Mir Asif performs precise, minimally invasive excision and deroofing of HS lesions with significantly less trauma than conventional open surgery.

Key advantages of the laser approach at Mirascare:

• Almost painless procedure with no major incisions
• Very few post-operative complications
• Significantly faster return to daily activities
• High precision especially valuable in sensitive intertriginous areas
• Active patient counselling on lifestyle factors and comorbidity management

When to Seek Specialist Care

If you have been experiencing recurring painful lumps, abscesses, or draining wounds in the armpit, groin, buttocks, or thigh areas — especially if these have persisted for more than three months or have recurred in the same locations — you should seek evaluation from a specialist experienced in HS.

HS is frequently misdiagnosed as simple boils, carbuncles, or skin infections, leading to years of ineffective treatment. A specialist assessment, including clinical examination and appropriate scoring using the IHS4 or Hurley staging systems, will determine the right treatment pathway — medical, surgical, or combined — for your specific condition.

At Mirascare Clinic in Gurgaon, Dr. Mir Asif Rehman offers precisely this expertise: an accurate diagnosis, a clear explanation of your disease stage, and access to the full spectrum of 2024–2025 guideline-aligned treatments, including advanced laser surgery.

Source 

https://onlinelibrary.wiley.com/doi/10.1111/jdv.20472

In some important case studies “Individuals with hidradenitis suppurativa (HS) possess a heightened susceptibility to cancer development. This include hematologic malignancies, solid tumors, and cutaneous squamous cell carcinoma (SCC) arising from HS lesions.”

Dr. Mir Asif Rehman explains that chronic inflammation and repeated scarring associated with severe or longstanding HS may lead to the development of squamous cell carcinoma (SCC), a type of skin cancer, particularly in areas affected by persistent lesions.

Key factors

• Patients with HS also have an increased risk of developing noncutaneous cancers.
• Malignancy is a comorbidity associated with HS.
• Both primary cancers and cutaneous metastases can masquerade as HS lesions.
• Hidradenitis suppurativa is linked to several comorbidities, including metabolic, cardiovascular, musculoskeletal, gastrointestinal, and mood disorders.

Types of Cancer Linked to HS:

• Squamous Cell Carcinoma (SCC) is most usually associated with chronic HS.
• Other malignancies, such as basal cell carcinoma or lymphoma, may also be associated, but this is extremely rare.

What can be the Warning Signs?

• Non-healing or rapidly growing lesions in HS-affected areas.
  • Changes in color, size, or texture of the skin around HS lesions.
  • Persistent pain or unusual discharge.

Hidradenitis Suppurativa (HS) is a persistent dermatological illness that predominantly impacts regions of the body where skin surfaces interlace. Dr. Mir Asif Rehman elucidates that hidradenitis suppurativa (HS) is marked by painful nodules, abscesses, and sinus tracts in areas susceptible to friction, perspiration, and hair proliferation.

Commonly Affected Areas that can be affected by HS:

1. Axillary Region: A often affected area due to perspiration and friction.
2. Groin area : Skin-to-skin contact and moisture collection are common causes of irritation in the inner thighs and groin.
3. Buttocks: Lesions often appear in areas of high friction, such as the intergluteal cleft.
4. Breast Region: Women may get HS beneath and around their breasts, particularly if they have large breasts or sweat a lot.
5. The labia in females and the scrotum in males may be affected, causing significant discomfort.
6. Thighs: Inner thighs are prone to lesions, especially in people with extra body weight.
7. Neck and Retroauricular Regions: HS lesions might appear in these areas less commonly, particularly in severe cases.

Prevention and Early Detection:

• Regular monitoring by a concerning doctor who are expertise in HS Treatment.
• HS should be treated early and effectively in order to reduce the amount of chronic inflammation.
• For the purpose of preventing complications, surgical treatment of chronic or severe lesions is recommended.

Dr. Rehman emphasizes that, while the risk of cancer in HS patients is minimal, it is critical to be cautious and seek medical assistance if any worrisome changes arise. Early intervention is critical for lowering the likelihood of problems.

Treatment of Hidradenitis Suppurativa

A range of treatments is available for individuals with this condition to alleviate discomfort and mitigate the indications or symptoms of their illness.

The primary therapy modalities for hidradenitis suppurativa include:

• Antibiotics,
• Immunosuppressants,
• Surgical intervention, and
• Topical therapies.

In extreme instances, surgical intervention may be required to excise all contaminated tissue to avert any future recurrence of the condition.

————————————————————————————————————————————————————————————-

Facts & Resource:

1. Mucinous adenocarcinoma of the buttock associated with hidradenitis:
   
   Kim SJ, Kim TG, Gu MJ, Kim S. Mucinous adenocarcinoma of the buttock associated with hidradenitis: A case report. World J Clin Cases 2020; 8(18): 4200-4206 [PMID: 33024779 DOI: 10.12998/wjcc.v8.i18.4200]
2. Cancer and hidradenitis suppurativa

https://www.sciencedirect.com/science/article/pii/S0738081X24001834

• Chronic hidradenitis suppurativa and perianal mucinous adenocarcinoma. A case report. – https://europepmc.org/article/med/17393769?utm_medium=email&utm_source=transaction&client=bot

• Hidradenitis suppurativa

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02475-9/fulltext