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Managing Hidradenitis Suppurativa on the Inner Thighs

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Imee Williams
Posted on August 4, 2022

Hidradenitis suppurativa (HS), also called acne inversa, is a chronic, inflammatory skin condition that causes painful, pea-size lesions under the skin. These lesions — also referred to as lumps, bumps, cysts, nodules, or abscesses — are found on areas of the body with a high number of apocrine sweat glands or where the skin rubs together. For many people, that includes the inner thighs.

“I have nodules in between my thighs, so it’s hard to comfortably walk,” one myHSteam member wrote. Another said, “My worst flare is on my inner thighs. It’s hard to walk, sit, or lie down.”

More than 4,000 members on myHSteam report experiencing HS symptoms on their thighs. Although there is currently no cure for HS, you can take many steps to manage symptoms and improve your overall quality of life.

Symptoms of HS on the Inner Thighs

The symptoms of HS vary, depending on the type of HS, severity of the disease, and 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 (called sinus tracts) and scarring
  • Hurley stage 3 — Many lesions throughout the body with tunneling and scarring
Hidradenitis suppurativa lesions often arise on areas where skin rubs together, such as the inner thigh shown here. Warmth, itchiness, or pain may signal an impending flare. (DermNet NZ)

Symptoms can occur even without a triggering event, but factors such as smoking, menstrual cycle, stress, excessive sweating, weight gain, and family history can raise the risk of developing lesions.

HS on the inner thighs may appear as blackheads or tiny, itchy bumps on one or both of the upper thighs, right below the pelvis. Often, the area will feel warm, itchy, or sore 12 to 48 hours before lesions show up. As the bumps grow, they can become painful and filled with pus or fluid.

HS lesions can last days to months, typically appearing as deep, pea-size bumps similar to acne cysts or boils. Sometimes larger lesions burst, draining foul-smelling pus. Over time, lesions may leave scars and form tunnels under the skin that connect with each other. Skin lesions can also recur, disappearing and then reappearing.

HS can have a tremendous impact on a person’s mental health and self-esteem. In a recent study, researchers who surveyed people living with HS found that depression was the most frequent comorbidity (co-occurring medical condition), reported by more than half of the respondents. People living with HS also have higher rates of anxiety, bipolar disorder, psychosis, and schizophrenia compared with those who don’t have the skin condition.

Treatments for HS on the Inner Thighs

Several treatment options for HS can help reduce symptoms and slow the rate of recurrence. Your dermatologist will help create a treatment plan based on the type of lesions, their location, and their severity. The most commonly prescribed and recommended treatments for mild HS (Hurley stage 1) affecting the inner thighs include:

One myHSteam member shared their positive experience working with a dermatologist to improve inner thigh symptoms: “I did steroid injections in my inner thighs, and I’d say it was completely worth it! I did have some pain after the injections, but the swelling went down instantly and I was able to walk with very little pain. After just two days, my skin was so smooth and clear, which I haven’t seen in years!”

Moderate and severe forms of HS (Hurley stages 2 and 3) in the inner thighs may require a combination of topical and oral medications and surgery. Oral options include:

In some cases, alleviating HS lesions may call for surgical procedures, such as:

  • Incision and drainage of abscesses
  • Deroofing (removing the skin that covers an abscess or sinus tract)
  • Wide excision (removing the entire lesion or sinus tract)

Other therapies, such as laser hair removal (using a carbon dioxide laser), low-dose radiation, and botulinum toxin A (Botox) injections, have been recommended as part of the treatment strategy for moderate to severe HS in the inner thighs. Laser hair removal may also benefit people with mild cases.

Management of HS on the Inner Thighs

Several risk factors have been associated with developing HS. Adopting certain healthy habits may also help control your skin disease. Try to:

  • Quit smoking.
  • Get enough sleep.
  • Reduce stress.
  • Lose weight, if you are overweight, or exercise regularly.
  • Eat a healthy diet.

At-Home Approaches

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

Scarring and tunneling can result from hidradenitis suppurativa lesions, shown here on the groin, near the inner thighs. Because of its many apocrine sweat glands, this area is particularly vulnerable to HS. (DermNet NZ)
  • Clean your inner thighs daily with an antibacterial or antiseptic soap or cleanser to prevent bacterial infections.
  • Wear loose-fitting clothing that doesn’t rub against the inner thighs.
  • Use a warm compress or heating pad on the inner thighs frequently.
  • Keep your skin cool and dry.

Avoid using harsh, fragranced skin products (lotions, perfumes, and body sprays) or hard-bristle brushes on the affected area. Also, don’t shave near breakouts on the inner thighs.

Some members of myHSteam have also shared at-home tips and recommendations:

  • “I soak my legs in a warm salt bath to open up the blackheads in my upper thighs. Then I softly scrub my thighs with an electric cleaning brush like the Clarisonic.”
  • “I apply tea tree oil and keep it bandaged when I go out.”
  • “Press warm tea bags on your boil as often as possible.”
  • “Clean all of your wounds daily with alcohol and cover them with Band-Aids to avoid rubbing, tearing, or bleeding.”
  • “Apply an anti-chafing gel to prevent flare-ups.”
  • “Ice your wounds nightly to reduce swelling.”
  • “Wearing boy shorts, women’s boxers, or long underwear reduced my flares and didn’t irritate the area.”
  • “Keep wounds clean and regularly change bandages or gauze, especially when it begins to smell.”

Speak with your health care provider about the best options for your HS before starting any lifestyle changes or adding these at-home recommendations to your daily routine.

Talk With Others Who Understand

Living with HS can be challenging, but you are not alone. On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 26,000 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Do you have HS on the inner thighs? Does a particular strategy help relieve the pain and itching? Share your thoughts in the comments below or by posting on your Activities page.

Posted on August 4, 2022
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Imee Williams is a freelance writer and Fulbright scholar, with a B.S. in neuroscience from Washington State University. Learn more about her here.

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