Hidradenitis suppurativa: reducing inflammation and healing skin through root cause resolution
Painful, recurring skin lesions can affect daily life and well-being. Functional medicine takes a whole-body approach, working to calm inflammation and support immune balance for lasting skin health.
The functional medicine approach to hidradenitis suppurativa
Looking for a treatment for hidradenitis suppurativa in Australia, or want to find out how to treat the condition naturally? This page covers:
At Melbourne Functional Medicine, we’ll work with you to detect and treat the root cause of your acne inversa so clear skin can be yours again, using our investigative, supportive, and personalised approach to your skin health.
What is hidradenitis suppurativa?
Hidradenitis suppurativa symptoms
Hidradenitis suppurativa, also known as acne inversa, is a skin condition characterised by large, persistent abscesses or boils that appear under the skin, typically in the armpit, perianal, breast fold and genital regions. These lesions are very painful, become infected and often rupture.
In addition to physical symptoms, hidradenitis suppurativa is associated with profoundly negative impacts on quality of life, mental health, social interaction and sexual function.
What is hidradenitis suppurativa?
Hidradenitis suppurativa symptoms
Hidradenitis suppurativa, also known as acne inversa, is a skin condition characterised by large, persistent abscesses or boils that appear under the skin, typically in the armpit, perianal, breast fold and genital regions. These lesions are very painful, become infected and often rupture.
In addition to physical symptoms, hidradenitis suppurativa is associated with profoundly negative impacts on quality of life, mental health, social interaction and sexual function.
Taking a different approach
Whilst affecting up to 4% of people, unfortunately acne inversa is under-diagnosed, therefore often untreated. Sadly, patients often avoid seeking help due to feeling embarrassed and ashamed, and when they do seek help through their GP, often symptoms don’t resolve, or they return. And because the condition is poorly understood by most healthcare providers, many acne inversa sufferers are left frustrated, because they seem to know more about their condition than their practitioners do.
The functional medicine approach is different, in that it uses the latest, most comprehensive understanding of the condition to find and address the factors that contribute to hidradenitis suppurativa. It is this holistic treatment approach taken by skin expert Rebecca Hughes that has helped Australians resolve symptoms for good.
What causes hidradenitis suppurativa?
What triggers hidradenitis suppurativa?
While the exact triggers of hidradenitis suppurativa are unknown, it typically appears at the onset of puberty, and occurs more in women than men, suggesting hormonal involvement. This is likely why many female patients report aggravations of their hidradenitis suppurativa prior to their menses as reproductive hormones fluctuate.
The affected skin areas (armpit, breast fold, genital and perianal regions) have dense amounts of apocrine glands, which are small structures attached to a hair follicle that often secrete skin oils.
These apocrine and follicular structures are affected by hyperkeratosis (thickening of the outer layer of skin by a protein called keratin) which blocks the outlet of the gland, creating congestion/blockage, inflammation and a favourable environment for bacteria to thrive.
A number of factors can contribute to acne inversa, however as each person is unique, factors involved in one person’s acne inversa can be completely different to another person’s. Following is an overview of these factors that our skin health practitioner Rebecca considers to determine what might be playing a role in each person’s skin issue.
Let's treat the cause of your acne inversa, naturally
Factors contributing to acne inversa
There are a number of known risk factors associated with acne inversa, with a higher incidence in people who:
- Have obesity
- Have metabolic issues like insulin sensitivity/diabetes and/or high cholesterol
- Have a family history of hidradenitis suppurativa
- Are of African American descent
- Are smokers, even in a person of healthy weight
- Have Crohn’s disease
Autoimmunity and associated inflammation – is hidradenitis suppurativa an autoimmune disease?
Autoimmune related inflammation and activity is involved in some types of hidradenitis suppurativa, with 17% of patients with Crohn’s disease experiencing the condition. In this scenario, the immune system dysregulation is what’s thought to cause an exaggerated and chronic inflammatory response. This means the immune system isn’t able to deal appropriately with the bacterial infection that occurs at the site of boils.
Suboptimal gut health/ compromised microbiome
If the acne inversa is autoimmune in nature, often underlying autoimmunity is suboptimal digestive health, typically with a disrupted gut microbiome – the colony of bacteria, yeast and fungi that live in the digestive tract and play a role in nutrient absorption and creation, as well as a healthy immune response. Often, patients with acne inversa are prescribed several rounds of antibiotics to treat the bacterial infection in the skin, which can disrupt the microbiome, with 64% of patients on antibiotic treatment often experiencing of digestive disturbances, and for women, 35% can experience vaginal candidiasis – a key sign of microbiome disruption in the vaginal canal.
Smoking – a major risk factor
98% of patients with hidradenitis suppurativa smoke, particularly in more severe cases. Nicotine can cause increased activity of sweat glands, and can impact the movement of immune cells responsible for managing infections, which could be partly responsible for ongoing infection. In some lab studies, nicotine has also been shown to promote the thickening of the skin and subsequent blockage of follicles that cause hidradenitis suppurativa.
Known toxins in cigarettes like polycyclic aromatic hydrocarbons compromise detoxification pathways, particularly those involved in the metabolism of the hormone oestrogen which has been implicated in the condition. Compromised detoxification pathways can lead to a higher body burden of other toxins that are known endocrine disruptors, and can directly or indirectly promote inflammation which exacerbates this inflammatory condition.
A sedentary lifestyle is also a key risk factor
The sites where acne inversa occurs are close to lymph glands that form the lymphatic system, a key pathway of detoxification that is often dubbed the ‘drainage system’ of the body, given it’s responsible for clearing out unwanted substances from tissues, including white blood cells involved in infections.
Unlike the cardiovascular system that has a pump (the heart) to circulate blood and substances around the body, the lymphatic system relies on the contractile force of muscles and other tissues that come with movement to work. An efficient lymphatic system is necessary not only to remove processed toxins from the body, but it’s also needed to clear out infections. Hence, those living a sedentary lifestyle can have poor lymphatic drainage, which may make the removal of infections in the boils challenging.
Risk factors for severe acne inversa
Often, patients with severe acne inversa have other conditions alongside the condition, such as diabetes, hypertension, psoriasis, obesity, and Inflammatory Bowel Disease.
The condition is often associated with other conditions and complications if left untreated, such as:
- Sinus tracts (tunnelling wounds)
- Fistulae (abnormal passages between organs)
- Scarring, squamous cell carcinoma
- Lymphedoema
- Reactive arthritis
- Chronic pain syndrome
- Crohn’s disease
- Anaemia
Living with this painful condition carries a mental and emotional burden that often results in depression and sexual dysfunction that often need to be treated concurrently.
Sadly, many people with acne inversa avoid seeking medical care because of shame or embarrassment, and in particular, concern that it’s an STD for those who experience boils in the genital regions. However, as skin health practitioner Rebecca Hughes says ‘The sooner you get a diagnosis and start treatment, the quicker and better the outcome without the risk of more serious issues cropping up’.
Addressing common misconceptions
Is hidradenitis suppurativa an STD?
Because acne inversa often shows up in the perianal and genital areas, people experiencing abscesses in these regions are prone to think it’s a sexually transmitted disease, however, this isn’t true. This is why acne inversa isn’t something to be ashamed of, and seeking medical diagnosis from a GP or gynaecologist should be sought straight away.
Is acne inversa the same as acne vulgaris?
A common misconception is that acne inversa is like acne (Acne Vulgaris), yet there are key distinctions between the two conditions. Acne vulgaris is driven by hormonal fluctuations in oestrogen or testosterone, whereas acne inversa isn’t necessarily hormonally directed, and often has an autoimmune component that drives the inflammatory response. In acne inversa, the boils appear in regions like armpits and groin, whereas acne vulgaris presents on the face, chest or back. While acne vulgaris pimples tend to come and go, acne inversa form painful boils that will persist until they rupture. Some boils can suppurate (burst), and some are hard inflamed nodules that get bigger or smaller.
Conventional hidradenitis suppurativa treatment
In Australia, typical first line medical treatment is to relieve symptoms and includes:
- antibiotics to control infection
- corticosteroids to control inflammation
- biological therapy to suppress inflammation, and
- surgery to remove stubborn lesions
Drug therapy in hidradenitis suppurativa is generally long term, which introduces the risk of adverse events related to the medicines or techniques. For example, as mentioned earlier, gastrointestinal disturbances and vaginal candidiasis are reported with long term antibiotic therapy.
Biological therapy (e.g. immunomodulators and monoclonal antibodies) are designed to help the condition by lowering inflammation which unfortunately also suppresses the immune system, leading to an increased risk of opportunistic infections. This can be unhelpful if the lesions are prone to bacterial infection, which can lead to chronic infection.
The deleterious effect of antibiotics on human microbiome diversity is well recognised, and in turn negatively impacts immune defence as well as inflammatory modulation – both critical functions in the development of hidradenitis suppurativa.
Topical cortisone reduces inflammation at the site, however long term use of steroids is linked with contact sensitisation, dermal skin infections, topical steroid withdrawal syndrome (TSW) and thinning of the skin.
Finally, surgical treatments are employed in advanced cases of hidradenitis suppurativa. Removal of lesions through a procedure known as wide angle excision is an invasive procedure, involving slow healing times that employ grafting and granulation techniques.
The Melbourne Functional Medicine approach to hidradenitis suppurativa
Holistic treatment for acne inversa
Our skin health practitioner Rebecca Hughes helps patients with hidradenitis suppurativa address their unique causes and contributing factors so they can resolve these painful lesions for good. This starts with a comprehensive assessment of a patient’s health, including:
- Health history
- Family history
- Diet and lifestyle
- Hormonal health
- Immune health
- Gut health
- Possible drivers of inflammation
Functional testing may be suggested to help identify the factors contributing to hidradenitis suppurativa and may include:
- Assessing for risk of autoimmunity, due to the known links with autoimmune conditions like Crohn’s disease
- Metabolic assessment given the association with weight gain
- Food sensitivities, which might be a driver of autoimmunity and inflammation
- Hormone testing where relevant
- Nutrient status e.g. vitamin D, zinc
- Comprehensive gut health assessment for functional markers that influence inflammation, intestinal hyperpermeability
- Environmental toxic burden that contributes to or drives inflammation, e.g. heavy metal, biotoxin susceptibility, smoking, alcohol
Following investigation, a personalised, holistic hidradenitis suppurativa treatment plan will be formulated, and with the support of a health coach – an expert in behaviour change – patients will implement a plan that may include:
- An anti-inflammatory diet
- Enhancing organs and systems of detoxification, e.g. lymphatic system, liver, gall-bladder, and digestive system
- A hormone-balancing protocol
- Stress management techniques like breathwork, meditation or mindfulness (to manage stress that can be a secondary or tertiary factor)
- Smoking cessation and alcohol reduction
- Supplementation of nutrients that either directly or indirectly lower inflammation, improve resistance to infection, rebalance hormones, enhance wound healing time, modulate the immune system, e.g. zinc, vitamin A, vitamin D and bioflavonoids
- Targeted protocols to address other factors like metabolic health, digestive disorders, or toxin exposure
- Referrals to trusted mental health care professionals for stress management
Are you ready for a personalised, natural functional medicine treatment? Our unique model of care was designed with you in mind. Find out how here, then book a call today!
Case study
See how our approach helps our patients achieve better health and richer lives.
Leanne was 25 when she came to see us and had been experiencing hard nodules in her groin since her teens. These fluctuated from mild to severe with her menstrual cycle. Antibiotics and the pill were prescribed, but Leanne had an adverse reaction to both.
Read Leanne’s story by hitting the button below
Leanne’s story
Leanne, 25yo, had been experiencing hard nodules in her groin since puberty which fluctuated with her menstrual cycle. She explained that sometimes the lesions would burst. At the time she came to us, she had one primary large lesion and several pea-size lesions that had persisted, cycling between mild and severe for the previous month.
Antibiotics had been prescribed, however these caused an allergic response. She had also been recommended to take the pill, though knew this wouldn’t be appropriate due to previous adverse events, like mood changes and acne vulgaris, to that medication as well.
Understanding the problem
A thorough case history revealed that whilst Leanne was within the healthy BMI range, she had gained 12kg since puberty. Given that weight gain is associated with the condition, this may have been a contributing factor.
She was also not having complete bowel motions. Daily complete emptying of the digestive system is a key way that the body detoxifies, including hormones. This was validated by functional hormone testing and gut function testing which showed that she had an imbalance in bowel flora that were impacting her digestion as well as phase 3 oestrogen detoxification.
Other factors that were likely contributing to Leanne’s case were low water consumption, a lot of convenience foods, and that she had been smoking for the last 6 years.
Implementing the solution
Leanne’s treatment plan included:
- Taking pre- and probiotics to enhance taking herbal medicines to restore bowel flora, which also eased bowel motions
- Specific plants such as linseed, broccoli sprout and rosemary to encourage healthy oestrogen metabolism
- Herbs to improve detoxification through the liver, gall bladder and kidneys. Supporting those reduces the burden on the skin.
- Nutrients to speed up wound healing time
- Specific antibacterial herbs to reduce risk of infection
- Gradual dietary modifications moving to a whole food diet of primarily meat, fish, vegetables, legumes and whole grains
- Increasing hydration to 1.5 – 2 L water daily
- Adjunct hypnotherapy for smoking cessation
Leanne’s health coach supported her through dietary and lifestyle modifications, guided her through the testing process and was available between appointments to navigate and interpret symptom changes.
Through discussions with her coach, it was discovered that Leanne had erratic sleep patterns. This arose as an important factor in her body’s ability to heal, as sleep is when the body should be resting, healing, detoxifying and integrating. Therefore, her health coach supported and guided Leanne to develop strategies and behaviours for consistent, restful sleep.
Achieving an incredible result
Within 2 weeks the largest active lesion had completely subsided, but there were still some small lesions that grew and remitted in a cyclical fashion alongside her menstrual cycle.
After 3 months of treating hormones, achieving great bowel health and sleep habits, these also resolved without any of the lesions rupturing, which was a huge success.
This was a huge relief to Leanne who was then able to focus her energy on smoking cessation, as this was identified as a significant risk for recurrence of the condition.
Ready for a personalised, natural functional medicine treatment?
Our unique model of care was designed with you in mind. Find out how, then book a call today
Frequently
Asked
Questions
Is hidradenitis suppurativa caused by stress?
Stress doesn’t directly cause hidradenitis suppurativa, but it can make symptoms worse. Stress affects hormone balance (such as oestrogen), increases inflammation, and impacts immune function – all of which can contribute to flare-ups. Managing stress is often an important part of a holistic treatment approach.
What vitamins help with hidradenitis suppurativa?
Nutrient needs vary for each person, but certain vitamins and minerals may support skin healing and immune balance in hidradenitis suppurativa:
- Zinc & Vitamin A: support skin repair
- Vitamin D: helps regulate the immune system and inflammation
- Chromium: supports glucose and insulin sensitivity
- Selenium: may aid immune balance
A functional medicine practitioner can help identify deficiencies and create a targeted plan.
Does tea tree oil help hidradenitis suppurativa?
Tea tree oil is not recommended for hidradenitis suppurativa. The infection is under the skin, not on the surface, so topical antibacterials don’t address the root problem. Applying tea tree oil to an open wound can also cause burning and irritation. If a boil bursts, a silver-lined dressing is a safer option to protect the area from further infection.
Does coconut oil help hidradenitis suppurativa?
Coconut oil won’t resolve hidradenitis suppurativa because the issue comes from blocked follicles beneath the skin, not surface bacteria.
HS is not caused by poor hygiene.
Instead, focus on addressing immune dysfunction and inflammation through a holistic, functional medicine approach. If a boil bursts, a silver-lined dressing is recommended to reduce infection risk.
Does hidradenitis suppurativa go away?
Hidradenitis suppurativa rarely goes away on its own. Conventional treatment often involves antibiotics, lancing a boil, or surgically removing it if it returns. However, relapses are common.
A functional medicine approach that addresses root causes such as immune dysfunction, hormone imbalance, and chronic inflammation may help reduce flare frequency and support long-term healing.
What herbal treatments help with hidradenitis suppurativa?
Herbal treatments can be tailored to your unique triggers and risk factors. A functional medicine practitioner may use:
- Rosemary, broccoli sprouts, flaxseed: support hormone balance
- Philodendron, cinnamon: improve insulin sensitivity
- Cleavers, poke root: support detoxification and lymphatic clearance
Because HS has multiple underlying drivers, herbs are most effective when part of a personalised, holistic treatment plan.
Is HS genetic, autoimmune, or hormonal?
Hidradenitis suppurativa (HS) is a complex condition influenced by several factors:
- Genetics: Many people with HS have a family history, and certain gene variants have been linked to the condition.
- Immune dysregulation: HS is now considered an immune-mediated inflammatory disease, meaning the immune system plays a central role, similar to autoimmune conditions.
- Hormones: Flares often occur around puberty, menstruation, or hormonal changes, suggesting hormones influence severity.
Rather than being caused by poor hygiene or surface bacteria, HS develops from a mix of genetic susceptibility, immune dysfunction, hormonal influences, and environmental triggers.
A functional medicine approach looks at all of these contributors to reduce flares and support long-term skin health.
Can’t find what you’re looking for? Reach out to the team directly – we’ll be happy to assist.
