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Abscesses that keep returning to the same spots
Abscesses that keep returning to the same spots: when they are not boils.
People living with hidradenitis suppurativa often reach a diagnosis after years, and almost always after hearing the same phrase: "they are just boils." In the early stages the picture really does resemble a series of boils or ingrown hairs, which is precisely why diagnosis comes late. But the most informative feature is not the individual nodule: it is that the lesions recur, and that they recur in the same areas.
The sites are characteristic. Armpits, groin, buttocks and other flexural areas are frequently affected by deep inflammatory nodules, abscesses and recurrent lesions. The process begins in the follicle: occlusion and rupture of the follicular unit, followed by a complex inflammatory response. Bacteria may take part secondarily in some lesions, but this does not make hidradenitis a simple succession of infections.
Over time the structure of the skin changes. Recurrences in the same territory can lead to scarring and to the formation of subcutaneous tunnels connecting inflamed areas. It is this evolution that makes early recognition important: what can be done depends on how advanced the picture is.
Finally, a point that is medical but also personal: hidradenitis does not depend on hygiene and is not contagious. Many patients spend years convinced that the lesions are caused by sweat or insufficient washing. Reading it as a hygiene problem adds stigma to a disease that is already heavy, and delays proper assessment.
The pattern matters more than the single lesion
An isolated boil says almost nothing. What orients the diagnosis is repetition: deep lesions returning to the same folds, leaving marks, sometimes connecting to one another. If it has been happening for months or years, that pattern is already diagnostic information — and bringing it to the visit, even just by describing it, is worth more than showing the lesion of the day.
How it shows
- Deep, painful inflammatory nodules, not superficial like a boil
- Lesions that always return to the same flexural areas
- Typical sites: armpits, groin, buttocks, under the breasts
- Abscesses that open and drain, with temporary relief
- Scarring in repeatedly affected areas
- In advanced cases, subcutaneous tunnels between inflamed areas
How we proceed
- 1Dermatological visit: history of the lesions, sites involved, course over time
- 2Examination of the affected areas and assessment of existing scarring and tunnels
- 3Assessment of the picture and of how advanced it is
- 4Definition of management, distinguishing the acute phase from long-term control
- 5Scheduled follow-up: this is a condition that is followed, not closed in one visit
Available treatments
- Dermatology visit
- Diagnostic assessment
- Management of the acute phase
- Long-term control
- Assessment of scarring
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Frequently asked questions
Why have I always been told they are boils?+
Because in the early stages they look very similar. The difference is not in the individual lesion but in its behaviour: a boil is an isolated episode, hidradenitis returns to the same flexural areas, often for years, and can leave scars. It is the pattern over time that distinguishes it, which is why telling the full history at the visit matters as much as showing the current lesion.
Is it my hygiene or sweating?+
No, and it is worth saying clearly because it is the most widespread belief and the heaviest to carry. Hidradenitis arises from a process involving the follicle and a complex inflammatory response: it does not come from insufficient washing and it is not contagious. Washing more, or more aggressively, does not change the mechanism and can further irritate already inflamed areas.
Are antibiotics alone not enough?+
Bacteria may take part secondarily in some lesions, but hidradenitis is not simply a recurrent infection: at its root is a follicular and inflammatory process. An approach built only on the idea of "treating the infection" therefore tends to control the episode without affecting the course. The plan must be decided at the visit, on the actual picture.
Does recognising it early change anything?+
Yes. Recurrences in the same territory can over time lead to scarring and the formation of subcutaneous tunnels, and that structural damage does not reabsorb. What can be done depends on how advanced the picture is: arriving earlier means having more margin.
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