Hidradenitis Suppurativa Treatment and How to Stop Feeling Guilty

There is something many patients tell us when they arrive at the consultation, with that mix of shame and desperation that you cannot hide, even in the mirror. It is that feeling of keeping your hands behind your back, avoiding sitting close to others because you fear smelling bad or staining your clothes. Imagine spending a workday in the office, feeling how the sweat accumulates in your axilla, but it is not just an odor; it is a painful inflammation that prevents you from moving normally. If you woke up that morning feeling that extra weight in your groin or genital area, you already know what I am talking about. You are not alone, nor are you crazy. This condition is bothersome and affects your quality of life, but there is a clear path to managing it without having to live with the constant fear of dirty clothes or sudden pain.

My name is Nathalie Morales, and I know how difficult it is to face a skin problem that makes you feel different in your own home. In consultation, we see many cases where people have tried home remedies or over-the-counter products without success, only to discover that the problem remains, sometimes worse. What we do is listen to your story, examine the lesions, and design a realistic plan. It is not about judging your skin or promising magical miracles that do not exist. It is about understanding why your body is reacting this way and helping you regain the mental peace and physical comfort you deserve.

Hidradenitis suppurativa is a chronic inflammatory disease that affects the apocrine sweat glands. These glands, which produce that specific sweat that decomposes with the skin’s acids and creates that characteristic odor, are the culprits. Instead of opening on the surface to exit to the outside, these glands form a subcutaneous duct that becomes obstructed. When it is blocked, the accumulated sweat generates pressure and causes it to rupture deeper in the skin, creating those hard, hot, and painful nodules. Over time, these nodules can fuse together forming a “canker” or fistula, an escape route that leaves a permanent scar and a continuous flow of thick fluid.

The most important nuance you must know is that many people believe this condition disappears completely with current treatments. The reality is that it is controlled very well, but it rarely disappears forever if the root cause is not managed. Think of it as a chronic disease similar to diabetes or hypertension; with proper care, you can live without bothersome symptoms for years, but if you stop caring for your skin or continue exposing yourself to triggers, it will reappear. It is vital to understand that it is not a simple bacterial infection like a common boil. It is an autoimmune disorder where the body’s defense system attacks its own tissues, although the bacteria Staphylococcus aureus is usually present and worsens the inflammation, it is not the sole cause of the problem.

In my consultation in Medellín, we address this problem with a multidisciplinary approach because a single pill rarely suffices to heal all the damaged tissue. If you have hidradenitis suppurativa and the damage has advanced, sometimes we need systemic medications that act on the immune system to reduce inflammation from within. We can also resort to specific biologics that block the body’s alarm signals. Additionally, we evaluate the need for local surgical procedures to clean the fistulas or decompress the nodules. In these advanced cases, systemic treatment is fundamental for the procedures to be effective and reduce the frequency of recurrences.

For you, the process begins with a thorough evaluation. We do not just look at what is visible to the naked eye; we analyze your complete medical history and ask about your daily habits. We identify if there are triggering factors such as obesity, smoking, or extreme stress that are exacerbating your skin’s inflammatory response. For example, tobacco damages the small blood vessels and reduces the oxygen reaching the skin, making it difficult for it to heal. Obesity increases friction between the folds of the skin, such as in the abdominal fold or groin, creating a warm, humid environment perfect for infection to establish and for the ducts to become obstructed more quickly.

A real scenario I know well is that of a thirty-year-old woman who works in logistics in northern Medellín. She began noticing small lumps after long workdays, carrying boxes or moving packages in cold, humid warehouses. Constant friction in her groin, combined with her physical constitution, led her to develop increasingly large nodules that hurt when walking. She thought it was just a hygiene or excessive sweating problem, but when the pain became unbearable and fissures with a bad odor appeared, she understood she needed professional help. With a combined treatment of oral medication to control systemic inflammation and procedures to clean the affected areas, she managed to drastically reduce the frequency of flares. Now she can work without pain and feels much more secure wearing her favorite clothes.

Signs You Should Consult

If you are experiencing any of these signs, it is time to seek specialized help before the problem becomes irreversibly worse. Small, hard nodules in the axilla, groin, or genital area that hurt to the touch are not normal. You are also concerned if you notice a very strong and persistent odor that does not disappear with common soaps. And if you have those deep, open scars that never close completely, leaving thick fluid or pus constantly flowing. These signals indicate that the disease is active and could be damaging healthy tissue if we do not intervene soon. Do not wait for it to become a giant abscess because the treatment will be more complex and painful in advanced stages.

Many people wonder if the prescribed medications have strong side effects or if they really work. It is true that some systemic therapies can cause fatigue or skin changes, but the benefits of stopping chronic inflammation and avoiding major surgeries usually outweigh those effects. Others are worried about the cost of long-term treatments. However, comparing it to the loss of work time due to pain, constant visits to the primary care physician, and spending on ineffective medications, you will see that investing in a specialist from the beginning is the most intelligent and economical option in the long run.

It is also common to ask if extreme hygiene helps cure it. What many do is wash their axilla and groin several times a day with strong soaps or aggressive antiseptics. While keeping the area clean is good, excessive cleaning alters the skin’s natural pH and can irritate the inflamed areas even more, worsening the condition. The key is gentle care: use neutral soaps, avoid friction with tight clothing, and keep the folds dry without drowning in unnecessary products.

If you have hidradenitis suppurativa and want to know what your real options are for managing it, do not look for quick solutions that do not exist. Schedule an appointment with me so we can evaluate your case calmly and design a personalized plan. If you have been feeling that constant discomfort for months and want to understand how you can regain your tranquility, write to me directly: Schedule a consultation.

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Note from Dr. Nathalie: Each patient is unique and their skin responds differently to treatment. The information in this article is for reference only and does not replace personalized clinical evaluation.