Hidradenitis Suppurativa Flares in Houston Summer: What Triggers Them and How Dermatologists Treat HS

‍This article is educational and does not replace an evaluation by a board-certified dermatologist. If you have a concerning skin change, please book a visit.

If you have had painful lumps in your armpits, groin, or under your breasts that come and go, drain, and sometimes leave scars, this is worth reading. That pattern is often hidradenitis suppurativa, a chronic inflammatory skin disease that is routinely misdiagnosed for years as recurrent boils or ingrown hairs. HS is more common than most people realize, affecting roughly 1% of the population (AAD), and it is not a hygiene problem or anything you caused. It is a medical condition with real, evidence-based treatment. This guide explains what HS actually is, how dermatologists stage it, why Houston's heat and humidity can make it harder, and the treatment options available in 2026, from first-line care to the biologics now approved for moderate-to-severe disease.

What hidradenitis suppurativa actually is

A chronic inflammatory disease of the hair follicle, not a hygiene problem

Hidradenitis suppurativa is a chronic inflammatory disease centered on the hair follicle. The current understanding is that the follicle becomes occluded and ruptures, which sets off an immune response in the surrounding skin (AAD; Alikhan et al., JAAD, 2019). Over time this produces the painful nodules, abscesses, draining tracts, and scarring that define the disease. It is not caused by poor hygiene, and washing more aggressively does not prevent it. Framing HS as a hygiene failure is both inaccurate and harmful, because it delays the dermatologic care that actually helps.

Where it shows up most often

HS affects areas where skin rubs against skin and where certain glands are concentrated: the armpits, the groin and inner thighs, the buttocks, the perianal area, and under the breasts. Lesions are frequently symmetric, appearing on both sides of the body, and tend to recur in the same locations. The combination of location, recurrence, and bilateral pattern is what distinguishes HS from an isolated boil.

How common it is and who it affects

HS affects roughly 1% of people, occurs more often in women than men, and typically begins after puberty and before age 40 (AAD). It disproportionately affects Black patients, and access to timely diagnosis and treatment has historically been unequal, which is part of why the average diagnostic delay is measured in years. None of these patterns reflect anything a patient did. They reflect biology and gaps in care.

How dermatologists stage HS

Dermatologists most commonly describe HS severity using the Hurley staging system, which guides treatment intensity.

• Hurley Stage I. One or more isolated nodules or abscesses without sinus tracts (tunnels under the skin) or scarring.
• Hurley Stage II. Recurrent nodules and abscesses with sinus tract formation and scarring, but with normal skin between separated lesions.
• Hurley Stage III. Diffuse involvement with multiple interconnected sinus tracts and abscesses across an area, with little normal skin in between.

Staging is not a verdict. It is a tool that helps match the intensity of treatment to the extent of disease, and patients can improve with appropriate therapy. Staging also reminds us that HS exists on a spectrum, and early diagnosis at Stage I gives the best chance to limit progression and scarring.

Why Houston summer makes HS harder

Heat, sweat, and the cutaneous microenvironment

Heat and sweat change the environment of the skin in body folds, the exact areas HS targets. Many patients report that hot, sweaty conditions precede flares, and Houston's summer keeps body folds warm and moist for months. While weather does not cause HS, it can raise flare frequency by worsening the local conditions in which lesions develop.

Friction in folds

Mechanical friction in skin folds is a recognized aggravator of HS. Tight clothing, prolonged sitting, body weight, and occupational movement patterns all increase rubbing in the armpits, groin, and under the breasts. In a hot climate, friction and sweat compound each other, which is why fabric and fit choices matter more here than people expect.

Humidity and skin maceration

Average relative humidity in Houston sits close to 75% annually (NOAA Houston). Persistent moisture in body folds can cause maceration, softening and breakdown of the skin barrier, which makes the folds more vulnerable to irritation and secondary infection. Keeping folds as dry and friction-free as practical is a core part of summer self-care for HS.

What we know about triggers

Smoking

Smoking is the strongest modifiable risk factor associated with HS, linked to both higher prevalence and greater severity (AAD; Alikhan et al., JAAD, 2019). Quitting is one of the highest-impact steps a patient can take, and we frame it as a modifiable risk factor, not a moral judgment. Support for quitting is part of comprehensive HS care.

Body weight and metabolic comorbidities

Excess body weight is associated with HS severity, and HS is also associated with metabolic conditions such as diabetes and cardiovascular disease (Alikhan et al., JAAD, 2019). Weight management may reduce flares for some patients by lowering friction and inflammation. We describe this as one modifiable factor among several, not as a cause patients are blamed for.

Mechanical friction and clothing choices

Because friction aggravates HS, clothing that reduces rubbing in affected folds can help limit flares. This is one of the few triggers a patient can adjust day to day, and it costs nothing to try.

Hormonal factors and menstrual cycle patterns

Many patients notice that HS flares track with their menstrual cycle, and HS often begins after puberty, which points to a hormonal influence in at least some cases. This is why hormonal therapy is part of the treatment toolkit for selected patients, discussed below.

How HS is treated in 2026

Treatment decisions depend on your individual skin, medical history, and goals. The information below describes how dermatologists evaluate options; it is not a prescription or a recommendation for any specific person.

HS is treated in a tiered way, matched to Hurley stage and to how the disease is behaving. Most plans combine several layers.

Lifestyle and topical or intralesional first-line care

For milder disease, dermatologists often start with topical antiseptic and antibiotic washes (such as chlorhexidine or topical clindamycin), measures to reduce friction and moisture, and intralesional corticosteroid injections to calm an individual inflamed nodule quickly (Alikhan et al., JAAD, 2019). Smoking cessation and weight management are addressed as part of the foundation rather than as afterthoughts.

Oral antibiotics and hormonal therapy

Oral antibiotics in HS are used for their anti-inflammatory effect as much as their antibacterial one. Tetracycline-class antibiotics and the combination of clindamycin and rifampin are common choices for moderate disease (Alikhan et al., JAAD, 2019). For appropriate patients, particularly those with cycle-linked flares, hormonal therapy such as spironolactone or combined oral contraceptives may be considered. These are individualized decisions made with a dermatologist.

Biologic therapy

For moderate-to-severe HS, biologic medications that target specific immune signals have changed what is possible. Three are FDA-approved for HS.

• Adalimumab, a TNF-alpha inhibitor, was the first biologic FDA-approved for moderate-to-severe HS, in 2015, and remains a well-established option with a long track record.
• Secukinumab, an interleukin-17A inhibitor, received FDA approval for moderate-to-severe HS in 2023, expanding the options for patients who do not respond adequately to or cannot use TNF inhibitors.
• Bimekizumab, which inhibits both interleukin-17A and interleukin-17F, received FDA approval for moderate-to-severe HS in 2024, adding another targeted mechanism.

Biologics are prescribed and monitored by a dermatologist, with screening before starting (including for tuberculosis) and ongoing follow-up. They modulate the immune system, so they carry specific infection considerations, and the decision to start one weighs the substantial burden of uncontrolled HS against the risks of treatment.

Surgical options

For lesions and tracts that persist despite medical therapy, procedural options can help. Deroofing removes the roof of a sinus tract to allow it to heal, and is tissue-sparing. Wide local excision removes more extensively involved areas and is reserved for advanced, scarred disease. Surgery is often combined with medical therapy rather than used alone, since it addresses existing damage but not the underlying inflammatory process.

What we tell Houston HS patients about summer self-care

Self-care does not replace medical treatment, but it can reduce flare frequency through a Houston summer.

Loose, breathable fabrics

Loose, breathable, moisture-wicking clothing reduces friction and traps less sweat in affected folds. Avoiding tight seams across the armpits, groin, and waistline can lower day-to-day irritation.

Antiperspirants and chlorhexidine washes

Gentle antiseptic washes such as chlorhexidine, used as directed by your dermatologist, can reduce bacterial load on the skin surface. Some patients benefit from antiperspirant use in affected areas to manage sweat, though this should be discussed with your dermatologist since tolerance varies.

Heat and sweat management at work and at home

Practical steps such as staying in air conditioning when possible, changing out of damp clothing promptly, keeping folds dry, and timing strenuous outdoor activity for cooler hours can all reduce the heat-and-sweat load that drives summer flares. Our pages on excessive sweating cover sweat management in more depth for patients for whom that is a major driver.

When to see a dermatologist

Consider an evaluation if you have recurring painful lumps in the armpits, groin, buttocks, or under the breasts, if lesions drain or have left scars or tunnels, if you have been treated repeatedly for "boils" without a clear diagnosis, or if flares are interfering with work, sleep, or daily life. Earlier diagnosis gives the best chance to control the disease before scarring advances. HS shares features with severe acne and is managed by the same specialists; our pages on acne treatment and acne scarring describe related care, and our broader clinical dermatology services page outlines how we evaluate inflammatory skin disease. We see patients from across the Houston area, including Clear Lake, Cypress, and River Oaks.

Frequently Asked Questions

Is hidradenitis suppurativa contagious?

No. Hidradenitis suppurativa is not an infection and is not contagious. It is a chronic inflammatory disease that involves the hair follicle and the immune system. You cannot catch it from another person or pass it to anyone. Secondary bacterial infection can occur in active lesions, but the underlying disease is inflammatory, not infectious.

Are these just boils or ingrown hairs?

HS is frequently mistaken for recurrent boils or ingrown hairs for years before it is diagnosed. The pattern is the clue: painful, recurring lumps in the same areas (armpits, groin, under the breasts, buttocks), often on both sides, that drain and sometimes leave scars or tunnels under the skin. Recurring lesions in these locations warrant evaluation by a dermatologist rather than repeated treatment as isolated boils.

Will losing weight cure my HS?

Weight loss does not cure HS, and HS is not caused by hygiene or body weight alone. The AAD identifies excess weight and smoking as modifiable factors that can influence disease severity, and weight loss may reduce flare frequency for some patients by lowering friction and inflammation. It is one part of a plan, alongside medical therapy, not a stand-alone cure.

Are biologics safe long-term?

The biologics approved for HS have established safety profiles from their clinical trial programs and from years of use across inflammatory diseases. Because they modulate the immune system, they carry a higher risk of certain infections, and your dermatologist screens for tuberculosis and other conditions before starting and monitors you over time. Long-term safety is assessed individually, weighing the disease burden of uncontrolled HS against the risks of treatment.

Does HS get worse in the summer?

Many patients report that heat, sweat, humidity, and friction worsen HS, and Houston's summer delivers all four. Heat and sweat alter the skin surface environment in body folds, and humidity contributes to skin maceration, while friction in folds is a recognized aggravator. Summer does not change the underlying disease, but it can increase flare frequency and discomfort, which is why summer self-care matters here.

How long does treatment take to work?

Timelines depend on disease stage and the treatment used. Topical and intralesional measures can calm an individual lesion within days. Oral antibiotics are typically assessed over weeks to a few months. Biologics are evaluated over a course of months, with response measured by a reduction in inflammatory lesions and flares. HS is a chronic disease, so treatment is about ongoing control rather than a one-time fix.

Closer

Hidradenitis suppurativa is a manageable chronic disease, not a hygiene failure and not something you caused. The years many patients spend being treated for "recurring boils" are years without the targeted care that modern HS treatment can provide, from first-line measures to FDA-approved biologics. Response is individual, and a dermatologist who understands HS can build a plan matched to your stage and your life in Houston's climate. If the pattern in this article sounds familiar, book a consultation at Bayou City Dermatology.

References

1. American Academy of Dermatology. Hidradenitis suppurativa: overview. Available at: aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview
2. American Academy of Dermatology. Clinical guideline: hidradenitis suppurativa. Available at: aad.org/member/clinical-quality/guidelines/hidradenitis-suppurativa
3. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa. Journal of the American Academy of Dermatology. 2019;81(1):76-90 and 91-101.
4. U.S. Food and Drug Administration. Humira (adalimumab) prescribing information, hidradenitis suppurativa indication (2015). Available at: accessdata.fda.gov
5. U.S. Food and Drug Administration. Cosentyx (secukinumab) prescribing information, hidradenitis suppurativa indication (2023). Available at: accessdata.fda.gov
6. U.S. Food and Drug Administration. Bimzelx (bimekizumab) prescribing information, hidradenitis suppurativa indication (2024). Available at: accessdata.fda.gov
7. HS Foundation. About hidradenitis suppurativa. Available at: hs-foundation.org
8. National Oceanic and Atmospheric Administration. Houston, Texas climate normals (relative humidity).