# Hidradenitis Suppurativa > Hidradenitis suppurativa for NEET-PG Medicine, covering Hurley staging, flexural sites, smoking and obesity links, antibiotics, adalimumab and surgical options. - Canonical URL: https://prepelephant.com/topics/neet-pg/medicine/hidradenitis-suppurativa - Exam / course: NEET-PG · Subject: Medicine - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-14 - Last updated: 2026-10-14 - Reference basis: Fitzpatrick's Dermatology; Rook's Textbook of Dermatology - How to cite: "Hidradenitis Suppurativa", PrepElephant, https://prepelephant.com/topics/neet-pg/medicine/hidradenitis-suppurativa ## Direct answer Hidradenitis suppurativa is a chronic, recurrent inflammatory disease of apocrine-bearing skin in the axillae, groins and inframammary folds, causing painful nodules, abscesses and sinus tracts. It is staged by the Hurley classification, which guides treatment from antibiotics and lifestyle measures in early disease to biologics such as adalimumab and surgery in extensive scarring. Smoking and obesity are the most important modifiable risk factors. ## What you must remember - **Typical sites:** axillae, groins, inframammary folds, and perianal and gluteal skin, where apocrine glands are concentrated. - **Hurley stage I:** isolated abscesses without sinus tracts or scarring. - **Hurley stage II:** recurrent abscesses with separate sinus tracts and scarring. - **Hurley stage III:** diffuse or confluent involvement with interconnected sinus tracts across the affected area. - **Risk factors:** smoking is the strongest modifiable factor, followed by obesity and metabolic syndrome; Crohn's disease is also associated. - **Early treatment:** lifestyle change with topical or oral antibiotics; a combination of clindamycin and rifampicin is commonly used for moderate disease. - **Biologic therapy:** the TNF-alpha inhibitor adalimumab is the established biologic for moderate to severe disease. - **Surgery:** deroofing or wide excision for scarred, recurrent sinus-tract disease, because recurrence after simple drainage is common. ## A stage-directed plan from first abscess to surgery A 27-year-old smoker with recurrent painful lumps in both armpits and the groin has moderate disease with sinus tracts. The steps below match each part of management to the Hurley stage and to the modifiable factors. 1. **Stage the disease:** assign the Hurley stage first, since the stage decides whether antibiotics, biologics or surgery will be the main treatment. 2. **Address modifiable factors:** smoking cessation and weight reduction improve outcomes and belong in every treatment plan, not as optional advice. 3. **Drain the acute abscess:** incision and drainage relieves pain from an established collection, but it does not prevent recurrence. 4. **Start systemic antibiotics:** clindamycin with rifampicin, or a tetracycline such as doxycycline, is used for moderate disease, with topical clindamycin for localised lesions. 5. **Escalate to biologics:** adalimumab is added when antibiotics fail in moderate to severe disease, and the response is judged over several months. 6. **Plan surgery for scarring:** deroofing or wide excision is considered for Hurley stage II and III disease with sinus tracts that keep recurring despite medical therapy. ## High-yield viva angles Exam questions usually turn on the correct diagnosis or on a treatment that suits a different disease. - **Trap:** treating hidradenitis suppurativa as acne — **Correct:** the disease affects apocrine-bearing flexural skin with sinus tracts and scarring, so acne-style topical therapy is not the answer. - **Trap:** repeated incision as the definitive treatment — **Correct:** drainage gives temporary relief, and recurrence is expected, so recurrent tracts need deroofing or excision. - **Trap:** calling a single boil on the back a hidradenitis lesion — **Correct:** the diagnosis needs recurrent lesions in typical flexural sites, so an isolated boil elsewhere points to a different cause. - **Trap:** dismissing smoking cessation once a biologic is started — **Correct:** smoking worsens the disease and blunts treatment response, so cessation is an active part of management. ## Frequently asked questions ### Which Hurley stage is treated mainly with surgery? Hurley stage III is the stage most often treated surgically, along with stage II disease that has sinus tracts and does not respond to medical therapy. Surgical options include deroofing and wide excision. Medical therapy usually comes first in early disease. ### What is the most important modifiable risk factor for hidradenitis suppurativa? Smoking is the strongest modifiable risk factor for hidradenitis suppurativa, and it is associated with more severe disease. Obesity and metabolic syndrome are also linked with the condition. Smoking cessation is therefore part of every treatment plan. ### Which biologic is used in moderate to severe hidradenitis suppurativa? Adalimumab, a TNF-alpha inhibitor, is the established biologic for moderate to severe hidradenitis suppurativa. It is used when antibiotics have failed and the disease continues to cause pain and recurrent abscesses. Its response is judged over several months of treatment. ### Which antibiotic combination is commonly used for moderate hidradenitis suppurativa? A combination of clindamycin and rifampicin is commonly used for moderate hidradenitis suppurativa, usually for a defined course. Doxycycline or other tetracyclines are alternatives, and topical clindamycin suits localised lesions. Long courses of antibiotics are avoided where possible because of resistance.