Hidradenitis Suppurativa Tunnels: Photos, Treatments, and More

If hidradenitis suppurativa (HS) is the “uninvited guest” of skin conditions, tunnels are the guest who
rearranges your furniture and then insists they were “helping.” HS tunnels (also called sinus tracts)
are channels that form under the skin after repeated inflammation. They can drain, scar, restrict movement, and
make flares feel like they have their own zip code.

The good news: tunnels are treatable. The even better news: you don’t have to DIY your way through this. With the
right mix of medical care, procedures, and day-to-day strategies, many people reduce drainage, pain, and future
tunnel formationand get back to living a life that isn’t scheduled around bandages.

What Are HS Tunnels (Sinus Tracts)?

HS is a chronic inflammatory skin disease that tends to show up where skin rubs togetherlike armpits, inner thighs,
groin area, buttocks, and under the breasts. It often starts with tender bumps or deeper nodules. When HS keeps
flaring in the same neighborhood, the repeated inflammation can lead to scarring and tunnel formation.

Think of an HS tunnel as a pathway connecting areas of inflammation beneath the skin. Some tunnels connect to the
surface through one or more openings; others are “hidden” under the skin and only show themselves through swelling,
pain, or recurrent flares in the same spot.

What Do HS Tunnels Look Like in Photos?

“Photos” can mean two different things here: (1) what tunnels look like on the surface, and (2) what they look like
under the skin (which usually requires ultrasound or other imaging). Since everyone’s HS is different, photos online
can be misleadinghelpful for recognition, but not for diagnosing your specific situation.

Surface clues you might see

• Multiple tiny openings in the same area (sometimes called “draining points”).
• Paired blackheads (often described as “double comedones”).
• Rope-like or thick scars and uneven texture where flares have happened repeatedly.
• Recurring swelling in the exact same spot that never quite “fully resets.”
• Drainage staining on dressings or clothing, especially with movement or pressure.

Under-the-skin “photos” (imaging)

Dermatology clinics sometimes use ultrasound to map HS tunnels beneath the skinespecially when the
surface doesn’t show the whole story. This can help guide procedures (like deroofing) and give a clearer picture of
severity than a quick glance alone.

Quick reality check: tunnels can look “small” on the outside and still be extensive underneath. HS is sneaky like that.

How Do HS Tunnels Form?

HS isn’t caused by poor hygiene and it isn’t contagious. Most experts describe HS as starting around the hair follicle,
with inflammation that can progress to deeper lesions. Over time, repeated cycles of inflammation and healing can:
destroy normal tissue, create scar bands, and form sinus tracts.

Common factors linked with HS (and tunnel risk)

• Genetics/family history: HS can run in families.
• Hormonal influences: Many people notice flares around menstrual cycles or puberty.
• Smoking: Associated with worse HS in multiple studies.
• Higher body weight: Not a “blame thing”just a risk factor that can increase friction and inflammation for some people.
• Friction, heat, sweating, stress: Common flare triggers reported by patients.

Tunnels often appear in more established disease. In the widely used Hurley staging system, tunnels
and scarring typically show up in Stage II and Stage III.

How Doctors Diagnose HS Tunnels and Severity

Clinical exam + history

HS is usually diagnosed by pattern: where lesions occur, how often they come back, and whether there’s scarring or
tunnel formation. You don’t need a fancy lab test to “prove” HSyour history matters a lot.

Staging and scoring

Many clinicians use the Hurley stages as a quick severity snapshot:

• Stage I: Abscesses/nodules without tunnels or scarring.
• Stage II: Recurrent lesions with tunnels and scarring; areas may be separated.
• Stage III: More widespread involvement with interconnected tunnels and significant scarring.

Some clinics also use scoring tools (like IHS4 or HiSCR in research) to track change over timebecause HS isn’t just
“mild vs. severe,” it’s “how are you doing this month?”

When imaging helps

Ultrasound can help identify hidden tunnels, define their extent, and guide procedures. This is especially useful when
you have pain or recurrent flares in one spot but the surface doesn’t show obvious openings.

Treatment Goals: What You’re Actually Trying to Accomplish

HS tunnel treatment usually aims to:

• Calm inflammation so fewer new lesions form.
• Stop chronic drainage and reduce odor/staining.
• Address existing tunnels (often with procedures) to prevent repeated flares in the same tract.
• Protect mobility and skin function (less scarring and pulling).
• Improve quality of lifesleep, sports, school/work, confidence, relationships.

Non-Surgical Treatments That Can Help (Even When Tunnels Exist)

Everyday skin care and flare care

• Gentle cleansing: Mild cleansers; avoid harsh scrubbing that irritates skin.
• Friction reduction: Soft, breathable fabrics; consider anti-chafe products if they don’t sting.
• Dressings: Non-adherent pads can reduce pain from sticking and help manage drainage.
• Warm compresses: Can soothe discomfort for some flares.
• Don’t squeeze/pick: It can worsen inflammation and increase tissue damage.

If you’re a teen reading this: HS can start in adolescence, and dealing with dressings at school is… a lot. You deserve
help that’s practical (and discreet). A dermatologist can recommend options that fit your routine and activities.

Topical and oral antibiotics

Antibiotics in HS are often used for their anti-inflammatory effect, not just infection control. Common strategies include:

• Topical clindamycin for milder disease or localized areas.
• Oral tetracyclines (like doxycycline) for mild-to-moderate HS.
• Combination oral therapy (such as clindamycin + rifampin) for more persistent disease, under clinician supervision.

Important: antibiotics aren’t forever solutions for tunnels. They can reduce inflammation and flares, but established
tunnels often need a procedural approach to truly “turn off” that tract.

Anti-inflammatory injections and short-term meds

Dermatologists sometimes use intralesional corticosteroid injections (a small steroid injection into a
painful lesion) to quickly reduce inflammation in a specific spot. Short courses of oral anti-inflammatory meds may
be used in select situations. The goal is relief and controlnot a long-term steroid lifestyle.

Hormonal and metabolic options

If flares track with hormonal cycles, clinicians may consider hormonal approaches (often in people who menstruate),
such as certain contraceptives or anti-androgen options. Some patients may also discuss metabolic options (like
metformin) with their clinician, especially if insulin resistance is part of the picture.

Biologics (targeted immune therapy)

For moderate-to-severe HSespecially with tunnelsbiologics can be a game-changer. These medications
target specific immune pathways involved in HS inflammation. As of recent years, multiple biologics have FDA
indications for HS in adults, and clinicians may also use other biologics off-label based on evidence and patient needs.

The vibe here is: fewer flares, less inflammation, fewer new tunnels, and improved daily functioning. Not a curebut
often meaningful control.

Pain, mental health, and quality of life

HS pain is real, and it can be exhausting. A comprehensive plan may include pain management strategies and mental
health support. Anxiety, depression, and social isolation are common with chronic draining diseasebecause humans
weren’t built to be worried about their armpit 24/7.

Procedures for HS Tunnels: The “Turn Off the Tunnel” Toolkit

When tunnels are present, procedures often provide the most direct improvementbecause a tunnel can act like a
“repeat offender” that keeps flaring.

Deroofing (also called unroofing)

Deroofing is a tissue-sparing procedure where the “roof” of a tunnel or chronic lesion is removed so
the area can heal from the inside out. It’s typically done with local anesthesia. Many dermatology and surgical teams
use it for persistent tunnels, often in Hurley stage I–II areas or localized disease.

Why people like it: it can reduce recurrence in that specific tract and often preserves more healthy tissue compared
with wider excision. Why some people don’t: healing can take time, and aftercare matters.

Excision (limited or wide)

Excision means surgically removing HS-affected tissue. The extent can range from limited removal of a
localized area to wide excision for more extensive disease. Wide excision is often considered for
severe, scarring, interconnected tunnels (common in Hurley stage III regions).

Closure methods varysometimes the wound heals gradually, sometimes surgeons use stitches, skin grafts, or flap
reconstruction depending on location and size.

Laser-based options

Laser treatments can help in different ways:

• Laser hair reduction (e.g., Nd:YAG): can reduce flares in some people by decreasing follicular triggers in affected areas.
• CO2 laser excision/ablation: used in some cases to treat localized HS and chronic tissue.

Not every clinic offers every laser, and insurance coverage variesso it’s worth asking what’s available locally.

Incision and drainage: quick relief, not a tunnel solution

Incision and drainage can temporarily relieve pressure in a painful abscess, but it often doesn’t prevent recurrence
because it doesn’t remove the tunnel-prone tissue or change the inflammatory cycle. For tunnels specifically, it’s
usually not the “finish line.”

What to Ask Your Dermatologist (Bring This List Like a Movie Script)

• Do you think I have HS tunnels/sinus tracts in this area?
• What’s my Hurley stage (or how severe is my disease), and what does that mean for treatment?
• Would ultrasound help map tunnels before a procedure?
• Am I a good candidate for deroofing vs. excision vs. laser?
• Should I consider a biologic (and which one makes sense for my situation)?
• What wound care supplies do you recommend for drainage and comfort?
• What are realistic timelines for healing and returning to sports/work?

Using photos the smart (and private) way

If you take photos to track HS for your clinician, keep it practical:

• Use consistent lighting and distance.
• Include a date in a note (or keep a simple log).
• Don’t share images publiclyHS is medical information, and you deserve privacy.
• If the area is sensitive and you’re a minor, involve a parent/guardian and follow your clinic’s instructions for secure sharing.

When to Get Urgent Medical Help

HS flares can be painful, but seek urgent care if you have signs of a serious infection or rapidly worsening symptoms,
such as fever, spreading redness, severe swelling, or feeling very unwell. When in doubt, contact your clinician or an
urgent care service.

Experiences: What Living With HS Tunnels Often Feels Like (and What Helps)

People living with HS tunnels often describe a strange mix of “invisible illness” and “impossible to ignore.” On the
outside, it might look like a small spot. On the inside, it can feel like a whole angry committee meeting under the
skinespecially in areas that move a lot (hello, walking, reaching, sitting, existing).

One of the most common experiences is the uncertainty: “Is this a new flare or the same old tunnel
acting up again?” Many people learn that tunnels can flare in patternslike recurring swelling in the exact same area,
drainage that reappears after friction, or tenderness that ramps up before anything is visible. Keeping a simple log
(date, location, trigger guesses, what helped) can make doctor visits much more useful than trying to remember
everything while you’re sitting in a paper gown.

Another big theme is wardrobe engineering. People often experiment with softer fabrics, looser cuts,
and strategic layers. It’s not about hiding; it’s about reducing friction and staying comfortable. Some folks swear by
breathable undershirts, bike shorts under dresses, or seamless athletic wear. The goal is fewer rub pointsbecause
your skin doesn’t need a daily “sandpaper audition.”

Then there’s wound care reality. Many people go through a trial-and-error phase before finding the
right combination of non-adherent dressings, absorbent pads, and skin-friendly tape (or alternatives that don’t rip
skin). A practical tip people often share: keep a small “HS kit” for school/workextra dressing, wipes, and a spare
shirtso you’re not forced into panic mode if drainage surprises you.

Emotionally, tunnels can hit hard. HS often affects intimate or high-friction areas, and people report feeling
embarrassedeven though this is a medical condition, not a personal failing. Many find that naming it out loud to a
trusted person (a parent, partner, close friend) reduces the mental load. Support groupsonline or in personcan also
help you feel less alone, especially when you’re navigating the “why is my body doing this?” phase.

When it comes to treatment experiences, a common turning point is realizing that tunnels usually need more than
“flare-only” care. People often say they wish they’d learned earlier that procedures like deroofing can
be a targeted way to stop a chronic tunnel from repeatedly flaring. Others describe biologics as the first time their
disease felt “calmed down” rather than constantly on the edge of another outbreak. Not everyone responds the same
way, but the pattern is consistent: a tailored plan beats random hope every time.

Finally, many people emphasize this: you deserve a clinician who takes HS seriously. HS is not “just
boils,” and tunnels aren’t “just annoying.” If you feel dismissed, it’s okay to seek a dermatologist with HS
experience. Getting the right care can be the difference between managing HS and being managed by it.

Conclusion

HS tunnels (sinus tracts) are a sign that inflammation has had time to build “infrastructure” under the skinrude,
but treatable. The most effective approach usually combines medical therapy to calm inflammation with procedures
(like deroofing or excision) to address established tunnels. Add supportive wound care, trigger management, and mental
health support, and you’ve got a plan that targets the whole picturenot just the latest flare.

If you suspect tunnels, don’t wait for the condition to “prove itself.” Early, consistent care can reduce scarring,
protect mobility, and help you get your time backbecause you have better things to do than manage an underground
tunnel system your skin built without a permit.

SEO Tags