Hidradenitis suppurativa (HS) in the groin is an inflammatory skin condition. Symptoms include abscesses, which are lumps in the skin that contain pus. Over time, narrow channels may develop under the skin and connect the lumps.

HS may also appear in other body parts, such as the armpits and the skin under the breasts.

While researchers do not fully understand the cause, the condition begins when hair follicles clog and rupture.

Doctors usually base a diagnosis on the signs and symptoms rather than lab tests. Treatment involves medications, such as antibiotics, but severe cases may require surgery.

This article explains HS in the groin, including symptoms, diagnosis, treatment, home remedies, causes, potential triggers, and prevention.

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HS, also known as acne inversus, is a lifelong, recurring inflammatory skin condition. According to the United Kingdom’s National Health Service (NHS), it commonly appears in the groin and genitals, but other common locations include:

  • the armpits
  • below the breasts
  • around the anus

The prevalence of HS ranges from 1–4%. Females have a three times higher risk of developing the condition, and it most frequently affects people aged 21–29 years.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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Hidradenitis suppurativa in the groin can present as recurring abscesses and nodules.

The first manifestation of HS is the development of a pea-sized lump in one place. After a few hours or days, it either vanishes or ruptures and leaks pus. This pus-filled lump is an abscess.

Next, new lumps frequently form nearby. When untreated, larger lumps form and spread. Over time, narrow channels that connect the lumps also develop under the skin. These may break out on the surface and exude pus.

The lumps may itch, cause pain, or develop a bacterial infection. Additionally, scars may form and restrict movement in the affected area.

Read more about HS.

Further symptoms

Overall further symptoms may include depression and anxiety.

People with the condition also have a higher risk of skin cancer, along with some types of arthritis, resulting in joint pain and stiffness.

Diagnostic tools involve a medical history and physical examination.

Lab tests are usually not involved in diagnosing HS, but in severe cases, a biopsy may rule out skin cancer. A bacterial culture may also be necessary when a doctor suspects a secondary infection or alternative diagnosis.

While imaging is not typically a diagnostic tool, a doctor may use ultrasound to assess the extent of the narrow channels.

It is important for a doctor to diagnose HS and to start a person on treatment early to prevent the condition from worsening. Medications may manage it in the early stages, but severe or persistent cases may require surgery.

According to the NHS, treatment options include the following:

Antibiotics

If the lumps develop a bacterial infection, the treatment is a course of antibiotics for 1–2 weeks.

When a bacterial infection is not present, low doses of antibiotics may prevent inflammation. The duration of this use of antibiotics is typically at least 3 months.

The antibiotics may be topical or oral, and the types may include:

Antiseptics

Along with other treatments, doctors often prescribe antiseptic washes, such as 4% chlorhexidine, to apply to the lumps.

Birth control

If the condition flares before a female’s monthly menstrual cycle, a doctor may prescribe oral birth control that combines estrogen and progesterone.

They may also provide other hormonal medications, such as spironolactone.

Retinoids

A dermatologist may prescribe compounds derived from Vitamin A called retinoids, such as acitretin (Soriatane) or isotretinoin (Absorica).

While they may help some people with HS, they are not as effective as they are for acne. A person should use them with caution and avoid them if pregnant.

Steroids

Steroid treatment is rare for HS, but systemic steroids, such as prednisolone, may be an option to decrease severe inflammation. Doctors may prescribe them in tablet or injection form. Steroids have side effects that include weight gain and sleep loss.

Immunosuppressive treatment

Severe cases may require injections of immunosuppressive medications, such as infliximab (Remicade) and adalimumab (Humira). However, these involve risks, so a dermatologist will prescribe one only if other treatments are ineffective.

Surgery

Surgery may involve the removal of the lesions, channels, and scars of the affected area. Another surgical choice is strong laser surgery to vaporize the lesions.

A person can also try the following home remedies.

Warm compresses

Dermatologists recommend applying warm compresses over the area using black tea or warm water. The black tea method involves:

  1. Steeping a cup of black tea for 10 minutes.
  2. Pouring it over a soft, clean cloth.
  3. Keeping the cloth over the area for 10 minutes.
  4. Repeating several times per day.

The warm water method involves:

  1. Placing a cloth under warm running water.
  2. Wringing out the excess water and putting the cloth over the lumps.
  3. Leaving the cloth in place for 10 minutes.
  4. Repeating several times per day.

Mediterranean diet

A 2018 study found a link between greater severity of HS and lack of adherence to the Mediterranean diet.

The findings indicate that nutrition may play a role in the condition. This suggests that a collaboration between a dermatologist and a nutritionist may help manage symptoms.

Zinc supplements

Older 2007 research examined the value of taking a daily zinc supplement in 22 participants with HS. The supplement appeared to lead to complete remission in eight people and partial remission in 14. Four out of the 22 participants experienced side effects, mainly gastrointestinal.

As with any supplement, a person interested in taking zinc should talk with a doctor first.

Researchers do not fully know the exact cause, but they believe the condition starts when keratin, a protein in the skin, clogs a hair follicle.

As the follicles become clogged, more lumps eventually form. When the follicle becomes overloaded with keratin, alongside sweat and bacteria, it can burst. This material can then spread to other hair follicles, thus clogging them, also.

Potential triggers

Potential triggers include smoking and being overweight. Studies suggest that 70–90% of people who develop HS smoke. In addition, being overweight increases a person’s risk of developing the condition and having a severe case.

There are different types of prevention. Primary prevention aims to keep a condition from manifesting. According to a 2019 study, this is impossible with HS because researchers do not fully understand the cause.

In contrast, secondary prevention is possible. This involves reducing the effect of a condition that is already present. Methods include:

HS of the groin is a lifelong, recurring inflammatory skin condition that manifests in lumps on the skin. It can spread and lead to the formation of narrow channels under the skin that connect the lumps.

An HS diagnosis often results from the recognition of the signs and symptoms.

Treatment may involve medications, surgery, or both. Limited research suggests that following the Mediterranean diet may help with the severity of HS. One study indicates that zinc supplements may help, but a person should talk with a doctor before taking them.

Smoking and being overweight are triggers for HS. Therefore preventive measures include stopping smoking and maintaining a moderate weight, if applicable.