Painful lumps in armpits and groin (hidradenitis suppurativa)

What it is

Recurrent painful lumps and tunnels in the armpits, groin and under the breasts.

How it works

Hair follicles become blocked and inflamed deep in the skin.

Why it matters on darker skin

Commoner in people of African descent; often diagnosed late.

Causes and triggers

Genetics, smoking, weight, friction.

What helps — and why it works

See a doctor early: treatments limit scarring. Expected timeline: months. Loose clothing: less friction. Expected timeline: immediate.

More detail

Hidradenitis suppurativa (HS) begins in hair follicles in the armpits, groin, buttocks and under the breasts. Blocked follicles rupture deep in the skin, triggering painful inflammation; over time, connected tunnels (sinus tracts) and rope-like scars can form, and lumps may leak fluid with an odour. HS is not an infection that can be caught, and it is not caused by poor hygiene — but people are often wrongly told it is, which delays diagnosis by years. It usually starts after puberty, is more common in women and in people of African descent, and is linked with smoking, obesity and family history. Early treatment can reduce flares and scarring: options include antiseptic washes, antibiotic courses, hormonal treatments for some women, modern injectable medicines for moderate to severe disease, and surgery for established tunnels. Pain relief and support for mental wellbeing are part of good care.

What to avoid and why

Avoid squeezing.

Common mistakes

• Thinking it is caused by poor hygiene.

Body care basics in a hot climate

Heat and humidity mean the body sweats more, which feeds the bacteria and yeasts that cause odour, rashes and some types of body acne. A daily lukewarm shower with a gentle, soap-free or mild cleanser, thorough drying of skin folds and between toes, and fresh, breathable cotton clothing prevent many problems. Moisturise straight after bathing while skin is still damp so water is sealed in; this matters even in humid months because frequent washing strips natural oils, and it matters most during harmattan. Avoid sharing towels, razors and sponges, which spread fungal and bacterial infections. When shaving, use a sharp blade, shave with the grain and do not stretch the skin; for curly hair a guarded trimmer is often better. Be cautious with body-lightening, 'carrot' or 'toning' lotions: many contain undeclared steroids or mercury. If a rash spreads, keeps coming back, or appears with fever, see a doctor rather than trying more creams.

Choosing body products

For most people an unscented, gentle cleanser and a plain moisturiser are enough. Antiperspirants containing aluminium salts are the most effective way to reduce sweating and are best applied at night to dry skin. Fragranced body sprays and deodorants are a common cause of allergy; fragrance-free options are kinder to sensitive skin. Aerosol products are easy to over-apply and some have been recalled for benzene contamination, so roll-ons and creams are a sensible default. For fungal rashes, plain antifungal creams such as clotrimazole are better than combination creams containing strong steroids, which can make infections spread. Always check for a NAFDAC number and a full ingredient list.

Questions to ask your doctor or pharmacist

Useful questions include: What do you think is causing this? Is it likely to come back, and how can I prevent it? Which products should I stop? How long before I should expect improvement, and when should I come back if it isn't better? Are there side effects to watch for? Is this treatment safe if I am pregnant, breastfeeding or for my child? Writing your questions down, bringing your products (or photos of their labels) and taking dated photos of the problem make an appointment much more useful.