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Why does HS keep flaring on my buttocks?
Hidradenitis suppurativa (HS) on the buttocks flares from ongoing follicle inflammation. Learn the triggers and how treatment can help limit tunnels and scars.
Key takeaways
Hidradenitis suppurativa (HS) can cause recurring, painful lumps on the buttocks. HS is a chronic inflammatory skin condition, not an infection caused by poor hygiene, and it is not contagious.
Friction, sweat, and heat can make buttock HS worse. Tight clothing, prolonged sitting, and rubbing against inflamed skin may aggravate existing lumps or trigger flares.
Flares can return in the same spot because inflammation persists beneath the skin. Over time, repeated flares may lead to tunnels under the skin and scarring.
Treatment can help reduce flares and prevent further skin damage. Depending on severity, options include topical treatments, oral medications, biologics, and procedures for persistent lumps or tunnels.
See a dermatologist if lumps keep returning, draining, or making sitting painful. Recurring lumps may be HS rather than ordinary boils or a pilonidal cyst. Seek prompt medical care if you develop a fever or spreading redness.
Hidradenitis suppurativa (HS) can keep flaring on the buttocks because it causes ongoing inflammation around hair follicles, sometimes in the same areas repeatedly. Friction, sweating, and heat can make symptoms worse, but they are not the underlying cause of HS.
If painful lumps keep returning to the same spot, they may need more than treatment for an individual flare. A dermatologist experienced in HS can help identify what's driving your symptoms, reduce future flares, and prevent tunnels or scarring.
What is hidradenitis suppurativa?
HS is a chronic inflammatory skin condition that causes deep, painful lumps, abscesses, and sometimes draining wounds. These lumps can heal and return, often in the same areas. Over time, repeated inflammation may form scars and tunnels beneath the skin, called sinus tracts.
HS is not caused by poor hygiene, and it cannot spread from person to person. As the Mayo Clinic explains, it is an inflammatory condition rather than a typical skin infection.
There is no single skin or blood test for HS. A dermatologist diagnoses it based on your symptoms, the location of your lumps, and whether they keep returning. Learn more in our guide to hidradenitis suppurativa.
Why the buttocks are a common place for HS
HS commonly affects areas where skin rubs together, including the buttocks, groin, inner thighs, armpits, and beneath the breasts.
The buttocks are particularly prone to irritation because of:
Friction: Skin rubbing against skin or clothing can aggravate inflamed areas.
Sweat and heat: Moisture and overheating may contribute to flare-ups.
Pressure from sitting: Sitting for long periods can put pressure on painful lumps.
Clothing: Tight underwear, pants, or thick seams can rub against sensitive skin.
These factors can worsen symptoms, but they do not cause HS on their own.
HS on the buttocks can make sitting, walking, exercising, and other daily activities uncomfortable. The American Academy of Dermatology (AAD) notes that painful lumps in this area can interfere with movement.
Men experiencing similar symptoms can also read our guide to recurring groin and buttock lumps in men.
Why flares keep coming back to the same spot
The exact cause of HS is still not fully understood. AAD's explanation of HS causes notes that HS begins in hair follicles. Experts believe a flare develops in a series of steps.
A hair follicle becomes blocked.
The blocked follicle becomes inflamed and bursts under the skin.
The inflammation spreads to nearby follicles.
A lump forms, drains, and heals with a scar.
Repeated flares in one area can connect into tunnels that keep draining.
The AAD also notes that breakouts sometimes develop in exactly the same spot. Draining a single lump can relieve pain, but HS usually needs ongoing treatment to reduce new flares.
This is why HS on the buttocks needs a longer-term plan rather than one-off care for each flare. Treating HS early can help limit tunnels and scarring.
Common flare triggers for this area
Triggers vary from person to person, and what sets off a flare for one person may not affect another.
Some of the factors below are linked to having HS or more severe HS. Others can set off a flare.
The AAD reports that 70% to 90% of people who get HS smoke cigarettes. Quitting is part of HS care.
Heat and sweat matter, and AAD self-care tips for HS note that sweating and overheating can cause a flare-up.
Tight clothing and thick seams can rub against sore lumps and make HS worse.
Shaving and waxing can irritate skin on the buttocks.
Hormonal changes may play a role, which could explain why some people flare before a period.
Excess weight is linked to HS and to more severe disease. The October 2026 guidelines found too little evidence that weight loss treats HS.
A simple flare log can help you spot your own pattern. Note the date, the location, and what was going on that week. Bring the log to your dermatologist.
Buttock HS, pilonidal cysts, and boils
These three conditions can look alike, and their location and pattern over time are the clearest clues. A clinician's exam is needed to tell them apart.
Condition | Where it appears | What it looks like | Pattern over time | What usually helps |
|---|---|---|---|---|
HS | On the buttocks and in other areas where skin rubs together | Deep, painful lumps that may drain and leave scars or tunnels | Returns in the same areas, often for years | A long-term plan from a dermatologist |
Pilonidal sinus or cyst | Usually in the cleft where the buttocks divide | A small hole or tunnel in the skin | Often no symptoms unless it becomes infected | An exam to decide whether treatment is needed |
Boil | Anywhere with hair follicles, often the buttocks and thighs | A tender, red, swollen lump that fills with pus | Usually drains and heals, most often within 2 weeks | Warm, moist compresses, and a doctor's care if it worsens or returns |
A pilonidal sinus is a small hole or tunnel in the skin. Its cause is unclear, but NI Direct explains how a pilonidal sinus forms, likely from loose hair piercing the skin. It often causes no symptoms unless it becomes infected.
The MedlinePlus guide to boils describes a boil as an infection that affects groups of hair follicles and nearby skin tissue. Boils are most common on the face, neck, armpit, buttocks, and thighs.
A boil usually needs to open and drain to heal, most often within 2 weeks. Warm, moist compresses can help, and you should never squeeze a boil.
Boil-like lumps that keep returning in skin folds may be HS, and you can learn how HS differs from boils. If lumps on your buttocks keep coming back, show them to a dermatologist.
Treatment options by severity
Treatment is matched to how severe your HS is and how often it flares. Most plans combine more than one approach. The goal is fewer flares, less pain, and fewer new tunnels.
In October 2026, the AAD and the HS Foundation published their first joint HS guidelines, with 37 evidence-based recommendations. Dermatologists describe severity with the Hurley stages, and you can read what the Hurley stages mean.
Daily care and topical treatment
Care often starts with gentle daily habits. Wash with an antiseptic or antibacterial wash, and avoid scrubbing. A warm compress can ease a painful lump.
A dermatologist may also prescribe a topical treatment, which is a medicine you apply to the skin. Options in the guidelines include clindamycin, resorcinol, and ruxolitinib cream.
For a single painful lump, a steroid injection into the lump can calm the flare. Your dermatologist may recommend it when one lump flares between visits.
Medicines for moderate to severe HS
When HS is more widespread or flares often, medicines that work through the whole body may help. Oral antibiotics can help reduce symptoms.
Biologics are injected medicines that target specific parts of the immune system. The guidelines strongly recommend four biologics for moderate to severe HS. These are adalimumab, bimekizumab, infliximab, and secukinumab.
The guidelines list other options a dermatologist may recommend:
upadacitinib, a pill that calms inflammation
spironolactone, a pill that acts on hormones
short courses of oral steroids during a hard flare
Your dermatologist checks how you respond and adjusts the plan over time. For more depth, read our guide comparing antibiotics, biologics, and surgery.
Procedures for tunnels and lumps that keep returning
When tunnels form or lumps keep returning in one area, a procedure may help. These are options a dermatologist may recommend:
Deroofing, a minor procedure that opens and flattens tunnels under the skin
Incision and drainage, which treats a painful abscess
Surgical removal of skin in areas that keep flaring
Laser hair removal, which may lead to fewer flares over time
Botulinum toxin injections, which are also listed in the guidelines
Procedures happen in person. Planning and follow-up can often happen by virtual visit. If you take adalimumab for moderate to severe HS, the guidelines suggest continuing it around the time of surgery.
Daily habits that reduce friction on the buttocks
Small changes in how you sit, dress, and care for your skin can reduce rubbing and heat on the area. These habits support medical treatment and do not replace it.
Sitting
Take standing breaks during long stretches of sitting.
A soft, breathable cushion may feel more comfortable than a hard seat.
Keep the area dry.
If you cycle, ask your dermatologist about your seat setup.
Clothing
Choose loose, breathable underwear and pants.
Look for flat seams and moisture-wicking fabric.
Change out of damp or sweaty clothes soon.
The AAD notes that clothing rubbing on a painful lump can irritate the skin and make HS worse.
Hygiene and wound care
Wash gently, without loofahs or brushes.
Pat the skin dry.
Cover a draining lump with a soft, absorbent dressing that won't stick.
Ask your dermatologist which dressings suit the affected area.
Hair removal
The AAD advises people with HS to never wax and to take precautions if they shave. Ask your dermatologist whether to shave affected skin at all. Laser hair removal is another option to discuss, and you can read more about hair removal options with HS.
Smoking
If you smoke, ask your dermatologist about support to quit.
When to see an HS specialist
See a dermatologist experienced in HS when lumps on your buttocks keep coming back. This matters most if they drain, scar, or make sitting hard. The AAD notes that HS is often confused with acne or infection, so people can go years without an accurate diagnosis.
Mayo Clinic advises seeing a dermatologist if your HS:
is painful
makes it hard to move or sit
does not improve in a few weeks
returns within weeks of treatment
appears in several areas
flares often
Bring photos taken during flares, a timeline of when lumps appeared, and a list of past treatments. Include antibiotics you have taken and any lumps that were drained.
At the visit, you can simply describe what you've noticed. For example, you might say, "I keep getting painful lumps in the same spot on my buttocks, and they drain."
Tono's HS Center of Excellence treats every stage of HS, from first flares to advanced disease requiring biologics. Care is longitudinal, with in-person exams, labs, and procedures coordinated when needed. A virtual visit is one way to reach the right specialist, including during a flare.
Appointments are available in 2 days or less, and no referral is needed. Most insurance is accepted, and every visit is led by a specialist. Tono has cared for more than 20,000 patients across a 33-state clinical footprint.
Signs that need prompt care
Contact a doctor promptly if a lump comes with any of these signs, which MedlinePlus lists for boils:
fever
red streaks spreading out from the lump
a large buildup of fluid in the area
other symptoms of infection
Tell the care team that you have HS, or that you may have it.
Frequently asked questions
Can HS cause boils on the buttocks?
Yes, HS lumps often look like boils. Lumps that keep returning in the same areas of the buttocks may be HS rather than simple boils.
Is HS on the buttocks caused by poor hygiene?
No, HS is not caused by poor hygiene. Gentle washing is part of daily care, but harsh scrubbing can irritate the skin.
Can HS on the buttocks go away?
HS is a long-term condition, but treatment can reduce flares and pain. Early treatment may also help limit tunnels and scarring.
Should I pop or drain an HS lump?
No, squeezing an HS lump can make the inflammation worse. Use a warm compress instead. Ask your dermatologist whether drainage or a steroid injection makes sense for that lump.
Can a virtual visit help with HS on the buttocks?
Yes, a virtual visit can help. A specialist can review your history and photos, then start or adjust treatment. Your specialist can also coordinate an in-person exam or procedure when needed.
Schedule an appointment with a Tono specialist, in person or virtually.
