Hidradenitis suppurativa (HS), a skin condition characterized by cysts of the sweat glands, can sometimes occur in the anal region. This is known as perianal HS.

HS is a chronic inflammatory condition that affects areas like the scalp, armpits, groin, and anus. It’s fairly common in adults, and a variety of factors can trigger it.

Here’s what else to know about the skin condition, including what symptoms to look for and how to manage it.

According to one 2021 paper, an estimated 1–4% of the global population have HS. Only about 6% of those people have perianal lesions, making it one of the rarest forms of the condition.

Even though the exact cause of HS remains unknown, scientists do know that the cysts grow in part due to blocked hair follicles in the sweat glands.

Other contributing causes and triggers of HS include:

  • Tobacco use: Some research has found a strong link between smoking tobacco and HS in general. An estimated 60–70% of people with HS smoke, according to the 2021 paper. By comparison, about 22% of the population uses tobacco. Those who smoke and have HS also may experience more frequent flares or more extreme symptoms.
  • Family history: The same paper states that up to 40% of people with HS have a family history of the condition.
  • Sex hormones: Since HS typically starts around puberty, some experts think that sex hormones may play a role in its development.
  • Crohn’s disease: Other research from 2021 suggests that those with Crohn’s disease may be up to nine times more likely to experience HS than those without. Both conditions may impact the anal area with overlapping symptoms.
  • Overweight or obesity: According to the 2021 paper, HS is 10 times more common in those with overweight or obesity than in those without.

Other potential associations include:

Although HS, in general, is three times more common in females overall, perianal HS is much more common in males.

HS typically occurs in sweat glands where the skin rubs together. This is why it’s common in the armpits and also may manifest in the anal area. Without treatment, this can become extremely uncomfortable and lead to complications like infections.

HS lesions are cyst-like and resemble a large pimple, boil, or abscess. Perianal symptoms may include:

  • deep, large, reddish, or purplish lumps that recur in the anal area
  • pain
  • discomfort
  • swelling
  • itching
  • pus (discharge)
  • drainage
  • bleeding
  • scarring
  • secondary infections
  • pilonidal sinus, which is a small hole in the skin at the top of the buttocks

Some people may mistake HS for a condition like:

  • Perianal cysts, abscesses, or fistulas: These are often due to an infection, and they have similar symptoms, like pain, swelling, and drainage.
  • Perianal candidiasis: This is a type of fungal infection that can lead to inflamed skin, itching, or pustules.
  • Sexually transmitted infections (STIs): These include genital herpes and human papillomavirus, and they can lead to perianal lesions or ulcers.
  • Ingrown hairs, acne, or hemorrhoids: Some people may mistake these for perianal cysts.

HS lesions tend to be red or purple, bulbous, and more painful than these conditions. They also may be characterized by boils with “tunnels” or small holes.

However, since these conditions all require a medical diagnosis and treatment, it’s a good idea to contact a healthcare professional if you suspect that you might have any of these.

HS breakouts go through periods of activity and remission. Even after they appear to heal, it’s not uncommon for new lesions to develop in the same place.

Perianal HS often requires a multidisciplinary treatment approach. Treatment may include:

  • topical treatments, like antibiotics, antiseptics, or corticosteroid injections
  • oral treatments, like antibiotics, retinoids, or immunosuppressants
  • lifestyle modifications, like quitting smoking, managing your weight, and avoiding common irritants and triggers
  • natural remedies you can try at home, including warm compresses, turmeric, honey, aloe vera, apple cider vinegar, zinc, and tea tree oil
  • surgical interventions, such as incising and draining the cysts, wide surgical excision (for more severe cases), skin grafting, or a temporary colostomy for severe perianal lesions

Although there’s not yet a cure for HS, there are various ways to manage it and live more comfortably.

When to contact a doctor

If you have any symptoms of perianal HS, such as cysts or pain in the anal area, contact a doctor for a professional diagnosis right away. Even if it’s not HS, it’s a good idea to test for other similar conditions, like genital herpes or an infection.

For that reason, STI testing may be necessary to accurately assess the symptoms. Your doctor may also need to do other imaging or biopsy tests to accurately diagnose the condition.

Early treatment helps prevent HS from worsening and can significantly improve your day-to-day quality of life.

Perianal HS is characterized by painful, inflamed lesions in the anal area. If you have any anal pain or cyst-like outbreaks, it’s advisable to contact a doctor right away for a complete diagnosis.

Some people may confuse HS with other conditions, like fistulas, STIs, or other infections. Diagnostic testing can help pinpoint the cause of the lesions. Quitting smoking, using medication, managing your weight, and getting surgery are all potential perianal HS treatments.

A doctor can help create an individualized treatment plan to help you manage your symptoms and live well.