If your “boils” keep coming back in the same places, read this

You get a painful lump under your arm. It swells over a few days, becomes hot and tender, and eventually bursts or gets drained. It heals. A few weeks or months later, another one appears — often in the same spot, or on the other side, or in the groin.

You have probably been given antibiotics more than once. Possibly you have had one lanced at a clinic. Somebody may have suggested, gently or otherwise, that you should wash more carefully or change your deodorant.

If that sounds familiar, what you have may not be boils at all.

Recurring painful lumps in the armpits, groin, inner thighs or under the breasts — appearing in the same places, over and over, for months or years — is the classic pattern of hidradenitis suppurativa. It is a real, recognised, treatable skin condition. It is far more common than most people realise. And it has nothing to do with how clean you are.

This page explains what it is, why it gets missed for so long, and what treatment looks like here in Nairobi.

What hidradenitis suppurativa actually is

Hidradenitis suppurativa — HS, sometimes called acne inversa — is a chronic inflammatory skin condition. Not an infection that keeps coming back. That distinction matters, because it explains why antibiotic after antibiotic never solves it.

It starts in the hair follicle, not the sweat gland

The older name suggested a sweat gland disease, and that idea has stuck around. Current understanding is different: the process begins when a hair follicle becomes blocked. Pressure builds, the follicle ruptures beneath the surface, and the immune system reacts to the spilled contents with intense inflammation.

That inflammation is what causes the pain, the swelling and the deep, firm lumps. Where it happens repeatedly in the same area, the body can form sinus tracts — narrow tunnels running under the skin, connecting one area to another, sometimes discharging fluid.

It is not caused by poor hygiene

Please read this twice if you need to.

HS is not caused by being unclean. Washing more will not prevent it, and harsh scrubbing of the affected areas usually makes things worse by adding friction and irritation. A great many people carry real shame about this condition because of an assumption that was never true.

It is not contagious

You cannot catch HS and you cannot pass it on — not to a partner, not to your children, not through shared towels or bedding.

There is a hereditary element. Roughly a third of people with HS have a family member who has it too, though often undiagnosed and described within the family as “boils that run in the family”.

Where it appears and what it feels like

HS shows up in areas where skin rubs against skin:

  • Armpits — the most common site by far
  • Groin and inner thighs
  • Under the breasts
  • Buttocks and around the anus
  • Occasionally the nape of the neck or the waistband area

What people describe:

  • A deep, firm, painful lump — not a surface spot, but something that feels rooted
  • A dull ache or burning for a day or two before anything is visible
  • Lumps that burst and discharge, sometimes with an odour that causes real distress
  • Areas that never fully settle between flares
  • Dark marks and thickened scarring where old lesions have healed
  • Pain when walking, lifting your arm, or sitting, depending on the site

The pain is genuinely significant, and it is routinely underestimated by people who have not had it.

Why it takes so long to get diagnosed

Most people with HS wait several years for a correct diagnosis — often a great deal longer. Not because it is difficult to identify, but because the individual lumps look like ordinary abscesses when seen one at a time by different clinicians who never see the pattern.

Often mistaken for How HS differs
Recurrent boils / abscesses Boils are scattered and random; HS returns to the same skin-fold sites repeatedly
Folliculitis Folliculitis is superficial and surface-level; HS lumps are deep and firm
Infected epidermoid cysts A cyst is usually single and stable; HS is recurrent and multi-site
Ingrown hairs from shaving Shaving can trigger a flare, but HS continues even when you stop
A sexually transmitted infection (when in the groin) HS is not infectious and does not respond to STI treatment

The signature to look for is repetition and location. If lumps keep returning to armpits, groin or under the breasts — and especially if there are two or more sites — that pattern is HS until proven otherwise.

If there is any doubt, or if something looks atypical, a skin biopsy settles the question rather than leaving you on another round of guesswork.

How severe is it? The three stages

Dermatologists grade HS using Hurley staging. It matters because it drives what treatment makes sense.

Stage What is happening Typical approach
Stage I Single or a few lumps and abscesses. No tunnels, no significant scarring. Topical treatment, medication to reduce flare frequency, trigger management
Stage II Recurrent lumps, separated from each other, with some tunnelling and scarring Longer-course oral medication, injections into active lesions, sometimes minor surgery
Stage III Widespread involvement across a whole area with interconnected tunnels Intensive medical management, surgical opinion, referral for advanced therapy

Most people who reach us are somewhere in Stage I or II — and importantly, early treatment genuinely changes the trajectory. The scarring and tunnelling of later stages develops over years of untreated inflammation. Getting on top of it early is the most valuable thing you can do.

What makes it flare

Triggers differ between people, but the well-established ones are:

  • Smoking. This is the strongest modifiable factor by some distance. Stopping does not cure HS, but it meaningfully reduces severity for most people.
  • Friction. Tight waistbands, underwired bras, rough seams, prolonged sitting.
  • Shaving and waxing the affected areas.
  • Heat and sweat — trapped moisture in skin folds.
  • Hormonal cycles. Many women notice flares in a predictable pattern around their period.
  • Body weight, mainly through increased skin-on-skin friction and its effect on inflammation. This is a mechanism, not a judgement — plenty of people with HS are not overweight at all.

There is also a well-recognised overlap with polycystic ovary syndrome, insulin resistance and inflammatory bowel conditions, which is one reason a proper assessment looks beyond the skin.

How hidradenitis suppurativa is treated

There is no single cure. What there absolutely is: effective control, far fewer flares, much less pain, and prevention of the scarring that causes long-term damage.

Treatment works on three fronts.

Settling an active, painful flare

When a lesion is acutely inflamed and painful, the priority is bringing that inflammation down quickly. Intralesional steroid injections — a small amount of steroid injected directly into the lump — can settle an active nodule within a day or two and often avoids the need to cut it open at all.

This matters more than it sounds. Repeated incision and drainage relieves pressure temporarily but does nothing to prevent recurrence, and every cut adds to the scarring.

Medical treatment to reduce how often flares happen

This is the core of long-term management, and it is tailored to you:

  • Antiseptic washes used on the skin folds, chosen to be non-irritating
  • Topical antibiotic preparations applied to affected areas
  • Oral medication courses — often longer than people expect, because they are being used to calm inflammation rather than to kill a one-off infection
  • Hormonal treatment, which helps a substantial number of women, particularly where flares track the menstrual cycle or where PCOS is in the picture
  • Treating what sits alongside it — insulin resistance and related issues, where relevant

Treating the tunnels and scarring

Where sinus tracts have already formed, medication alone will not close them. Established tunnels usually need a procedural approach, and extensive Stage III disease warrants a surgical opinion.

What we can and cannot do locally

An honest word. For severe HS, biologic medications are the most significant advance of the last decade. They are available in principle in Kenya, but they are expensive and access is limited — and it would be misleading to build your hopes on them as a first step.

What we can realistically do here is diagnose you properly, stage the condition, settle active flares, put you on medical management that reduces flare frequency, and refer onward where the condition genuinely needs it. For most people at Stage I or II, that is exactly what changes things.

HS on deeper skin tones

Two things are worth stating plainly.

First, HS appears to be more common, and often more severe, in people of African descent. Despite that, most published photographs and patient information show the condition on white skin, which makes self-recognition harder.

Second, the marks left behind behave differently. Post-inflammatory hyperpigmentation is more pronounced and more persistent on deeper skin tones, and the raised scarring that follows repeated flares can tend toward keloid formation in some people.

That shapes how we treat: reducing inflammation early and avoiding unnecessary cutting isn’t only about comfort, it is about what your skin will look like in five years. Where keloid scarring has already developed, that can be addressed too — see keloid treatment and removal.

Living with it: what genuinely helps

Small, practical things that patients consistently report make a difference:

  • Loose, breathable clothing — cotton over synthetics, especially in the affected areas
  • Rethink the bra if lesions sit underneath the breast — non-wired, soft-seamed
  • Stop shaving affected areas during a flare; discuss alternatives for the longer term
  • Keep folds dry — pat, don’t rub; a plain absorbent powder can help
  • Warm compresses on an early tender lump, before it is fully formed
  • Don’t squeeze or lance it yourself — this drives inflammation deeper and worsens scarring
  • Get help with stopping smoking if you smoke — it is the single highest-impact change available
  • Track your flares against your cycle, stress and clothing. Patterns emerge, and they are useful.

One more thing, and it is not a medical tip. HS carries a heavy psychological load — the pain, the discharge, the worry about odour, the clothes you stop wearing, the intimacy you avoid. That is a normal response to a genuinely difficult condition, not weakness. It is worth raising at your appointment.

What your first appointment looks like

  1. We listen to the history. How long, which sites, how often, what has been tried. This is where the diagnosis usually becomes clear.
  2. We examine the affected areas and stage the condition.
  3. We check for what travels with it where relevant — hormonal and metabolic factors.
  4. We settle anything acutely painful, often the same day.
  5. We build a plan covering both flare control and long-term reduction, and explain what to realistically expect and when.

Appointments run from 8:30am on weekdays, and Saturday afternoons are usually quieter if you would rather come when the clinic is less busy.

Getting to the clinic

We are on the 2nd floor of Landmark Plaza, Argwings Kodhek Road, on the Hurlingham edge of Upper Hill — a short drive from Kilimani, Kileleshwa and Lavington.

Frequently asked questions

Is hidradenitis suppurativa curable? There is no cure, but it is very treatable. The realistic goal is long stretches without flares, far less pain, and preventing the tunnelling and scarring that cause lasting damage. Many people reach a point where it barely interferes with daily life.

Is it caused by poor hygiene? No. This is the most damaging myth about HS. It is an inflammatory condition that begins in the hair follicle. Washing more will not prevent it, and scrubbing the area usually makes it worse.

Is it contagious? No. You cannot pass it to a partner, a child or anyone else.

Why do antibiotics only work for a while? Because HS is not fundamentally an infection. Antibiotics are used in HS largely for their anti-inflammatory effect, which is why the courses are often longer than you would expect for a boil — and why a short course clears a flare without stopping the next one.

Should I have lumps drained when they are painful? Draining relieves pressure but does not prevent recurrence, and repeated cutting adds to scarring. Where possible we prefer to settle an acute lesion with an injection. Sometimes drainage is still the right call — but it should be a considered decision, not the default.

Does it run in families? Frequently. About a third of people with HS have an affected relative, often undiagnosed and described as “boils”.

Will it leave scars? Untreated, over years, yes — that is precisely what early treatment aims to prevent. Existing dark marks and raised scars can also be treated.

Can it start in teenagers? Yes. HS typically begins after puberty and often in the late teens or twenties. Early diagnosis in a teenager is especially worthwhile. See paediatric dermatology.

I have lumps in my groin — could it be something else? It could. Groin lesions have several possible causes and warrant proper assessment. Dr Nancy is a consultant dermatologist and venereologist, so both dermatological and genital skin and STI causes can be assessed in the same appointment.

Do I need a referral? No. You can book directly.

Book an appointment

If you have been managing this alone for years, or being treated for boils that were never boils, a proper diagnosis changes what happens next.

We open at 8:30am Monday to Friday and 9:00am to 4:00pm on Saturdays.

Landmark Plaza, 2nd Floor, Argwings Kodhek Rd, Nairobi
Call or WhatsApp 0728 566990
info@skinbydrnancy.com

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