Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, inflammatory skin condition. People who have HS present with acne-like lesions in certain areas of the body where there are high numbers of apocrine sweat glands. These sweat glands are found primarily between the buttocks, armpits, and groin. However, HS can also affect areas of skin that rub against each other such as the genital area, inner thighs, and under the breasts. Skin lesions can be deep nodules or tunnels and are quite painful.

If you have HS on the buttocks, you are not alone. There are more than 4,700 members on myHSteam who also have this condition. “I’ve been dealing with HS for over 10 years,” wrote a myHSteam member. “These last two years, my mobility declined. I’m unable to cycle or sit normally.”

There is currently no cure for HS and the underlying cause remains unknown. It is critical to begin treatment early in your disease so that you can better manage your symptoms and improve your overall quality of life.

Symptoms of HS on Buttocks

The symptoms of HS vary in every person and depend on the type of HS, the severity of the disease, and the area of skin affected. The Hurley staging system is used to characterize the type of HS:

• Hurley stage 1 — Single or multiple lesions with minor scarring
• Hurley stage 2 — Single or multiple lesions with some tunneling and scarring
• Hurley stage 3 — Many lesions throughout the entire body with tunneling and scarring

Symptoms can often be triggered by family history, smoking, menstrual cycle, stress, excessive sweating, or weight gain. Early signs and symptoms of HS on the buttocks include pain, burning, itching, and excessive sweating (i.e., hyperhidrosis). These symptoms occur for 12 to 48 hours before the onset of the skin lesion.

Skin lesions can appear on the buttocks, between the buttocks, and on the perianal area (skin surrounding the anus), and can last for days to months. The skin lesions can appear as a deep pea-sized bump similar to an acne cyst or boil. Some of the skin lesions will grow in size and burst, draining out foul-smelling pus. Over time, skin lesions may leave scars and form tunnels under the skin that interconnect with each other. Skin lesions can also be recurrent, disappearing, and then reappearing in a given period. “I have multiple painful boils and tunnels under the skin. My skin has darkened, and I have a burning sensation,” shared one myHSteam member.

Treating HS on the Buttocks

Although there is no cure, there are several treatment options available to lessen your symptoms and reduce the rate of recurrence. Your dermatologist will help create a treatment plan based on the type of lesions, the area of skin affected, and the severity of HS. The most commonly prescribed and recommended treatments for mild HS (Hurley stage 1) include:

• Topical agents (lidocaine and anti-inflammatories)
• Topical antibiotics (clindamycin or dapsone)
• Pain relievers (acetaminophen)
• Corticosteroid injection

One member from myHSteam shared their experience with topical agents. “Using lidocaine has somewhat helped me with the pain on my buttocks. I completely cover the area of skin with the cream, gently rubbing in light circular motions. I don’t cover my lesions and let the medication dry. I only cover my lesions when they are leaking.”

Moderate and severe forms of HS (i.e., Hurley stage 2 and Hurley stage 3) may require a combination of topical and oral medications and other therapies. Some oral medications include:

• Oral antibiotics (clindamycin, rifampin, or gentamicin)
• Oral retinoids (acitretin)
• Oral anti-inflammatories
• Corticosteroids
• Hormonal medications (birth control pills, spironolactone, or finasteride)
• Tumor necrosis factor-alpha inhibitors (Humira)

Other therapies such as laser hair removal (carbon dioxide laser therapy), radiation therapy, and surgical treatments to remove damaged tissue have shown to be of some benefit for treating moderate to severe HS. Laser hair removal may also benefit people with mild HS.

How To Manage HS on the Buttocks

There have been several risk factors associated with the development of HS. Changing certain lifestyle habits or adopting new ones — quitting smoking, exercising daily, and eating a healthy diet — may also help control the disease.

Weight Loss

Studies have found that being overweight, obese, or having metabolic syndrome is an associated risk for developing HS. People who are overweight or obese tend to sweat more, have greater inflammation throughout their body, and have more skin irritation due to more friction on their body. A small study found that for people who lost 15 percent or more of their body weight, about 50 percent of participants had their HS clear up, and about 20 percent of participants had decreased the amount of HS lesions.

Weight loss or maintaining a healthy weight can reduce your risk of an HS flare-up or worsening symptoms. Many people with HS on their buttocks avoid physical activities because of their painful skin lesions. In this case, swimming may be a great exercise option to not only lose weight, but also aid in relieving their painful lesions.

Quitting Smoking

Smoking cigarettes is associated with HS. Experts have found that around 70 percent to 90 percent of people who develop HS also smoke. Quitting smoking can help prevent worsening HS symptoms and reduce your risk of flare-ups.

Diet

What you eat may affect your HS. Some foods may trigger flare-ups, and others can help prevent them. A few small studies have found that avoiding dairy products (cheese, butter, and cow’s milk), sugary foods (soda and candy), and brewer’s yeast (found in soy sauce, beer, and wine) may lessen flare-ups and sometimes clear HS. Changing your diet and adopting healthier eating habits that include foods high in fiber (fruits, vegetables, and whole-grain oats) and containing omega-3 fatty acids (salmon, sardines, and walnuts) may help reduce inflammation, balance hormones and blood sugar levels, and relieve your HS symptoms.

Some dermatologists have reported seeing improvements when some people with HS followed a Mediterranean diet or a plant-based diet. It is important to first speak to your dermatologist or primary care provider before changing your diet.

At-Home Recommendations

In the early stages of HS, you may be able to manage your flare-ups by following these at-home tips:

• Stop using harsh products on the skin.
• Stop using cleaning tools on the skin (i.e., loofahs, washcloths, brushes).
• Don’t shave near breakouts on the buttocks.
• Clean buttocks daily with antibacterial soap or cleanser.
• Wear loose-fitting clothing to prevent rubbing or friction against the skin.
• Use a warm compress or heating pad on the buttocks for 10 minutes at a time.
• Keep your skin cool and dry.

Some members on myHSteam also shared their at-home tips:

• “Warm baths with pure Epsom salt soaking solution.”
• “Bleach baths!!!!”
• “I use non-stick pads on my buttocks, which don’t hurt when I take them off.”
• “Keep your buttocks dry and clean.”
• “I apply a clear petroleum jelly to avoid further irritation to draining lesions.”

Speak with your doctor about the best options for your HS and before making any lifestyle changes or adding these at-home recommendations above.

Talk With Others Who Understand

You don’t have to feel isolated or alone. On myHSteam, the social network for people with hidradenitis suppurativa, more than 23,200 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Are you living with hidradenitis suppurativa? Share your thoughts in the comments below or by posting on myHSteam.