PIP for Hidradenitis Suppurativa - Can You Claim? Guide 2026

Hidradenitis suppurativa (HS) is a chronic painful skin condition causing recurrent abscesses, boils and tunnels, typically in armpits, groin, buttocks and under breasts. The pain, wound management and psychological impact can be severely disabling. Many people don't claim because they're embarrassed or don't think a "skin condition" qualifies. It does.

Which Activities Does HS Affect?

Preparing Food (Activity 1) – Abscesses in armpits affecting arm lifting. Pain in groin and buttocks making standing difficult. Open wounds creating infection risk around food.

Washing and Bathing (Activity 4) – This is often the highest-scoring activity. Open wounds making washing extremely painful. Water hitting active lesions is agonising. Need to wash around wounds carefully, change dressings after washing. If you need help from another person, this scores 2-4 points.

Dressing (Activity 6) – Clothing rubbing against abscesses causing severe pain. Need for special clothing. Bandages needing adjustment.

Managing Therapy (Activity 3) – Daily wound care: cleaning, packing, dressing wounds (30-60 minutes). This only counts as therapy when another person has to supervise, prompt or assist with it, and only the time they spend helping counts towards descriptors 3c-3f. Multiple medications (antibiotics, biologics, pain relief) are medication, so needing help or an aid with them is descriptor 3b, 1 point, however long they take. Dermatology appointments and surgical drainage happen at hospital, so they are evidence of severity rather than Activity 3 hours.

Managing Toilet Needs (Activity 5) – When HS affects groin, buttocks or perianal area, using the toilet is extremely painful. This is deeply personal but critical PIP evidence.

Engaging with People (Activity 9) – Profound embarrassment and shame. Odour from draining wounds. Fear of leakage through clothing. Depression and social withdrawal. Can score up to 8 points.

Moving Around (Activity 12) – Abscesses in groin and inner thighs making walking painful. Each step causes friction on affected areas.

Be Graphic and Specific

Don't write "I have skin problems." Write: "I have open draining wounds in my armpits and groin that leak pus and blood onto my clothing. I change dressings 2-3 times daily. Pain prevents lifting my arms or walking without severe discomfort."

What Evidence Helps?

• Dermatologist letters with Hurley staging
• Surgical records
• Wound care nurse letters
• Dated photos
• Mental health professional letters
• Carer statement

Severity Staging

Ask your dermatologist for your Hurley Stage rating. Stage I (single abscesses), Stage II (recurring abscesses with sinus tracts) or Stage III (diffuse interconnected tracts across entire areas). Higher staging is stronger PIP evidence. Even Stage I can qualify if it significantly affects daily activities on most days.

The Psychological Impact

HS causes profound depression, anxiety, and social isolation. The odour from draining wounds, the fear of leakage through clothing and the pain during intimate situations destroy confidence and relationships. Many people with HS become virtually housebound during flares. Claim for the mental health impact SEPARATELY - it scores independently on Activity 9 (engaging with people) and can add 2-8 points.

Hurley Staging in Detail

• Stage I: Single or multiple isolated abscess formation, no scarring or sinus tracts. Often qualifies for PIP if pain and flares affect daily life on most days.
• Stage II: Recurrent abscesses with sinus tract formation and scarring. Single or multiple widely separated lesions. Usually qualifies for at least standard daily living.
• Stage III: Diffuse or near-diffuse involvement with multiple interconnected tracts and abscesses across entire anatomical area. Almost always qualifies for enhanced daily living.

Modern dermatology also uses IHS4 score (International Hidradenitis Suppurativa Severity Score) combining nodule count, abscess count and draining tunnel count. IHS4 score over 11 is severe.

Treatment Pathway and PIP Evidence

• Topical clindamycin: Mild HS only
• Oral antibiotics (long-term): Doxycycline, tetracycline, clindamycin + rifampicin combination
• Hormonal treatments: Combined contraceptive pill, spironolactone, finasteride
• Metformin: Sometimes used, particularly with insulin resistance
• Biologics: Adalimumab (Humira) is licensed for moderate-severe HS. Other biologics increasingly used (secukinumab, ustekinumab, bimekizumab).
• Surgical interventions: Incision and drainage, deroofing, wide local excision with grafting
• Laser therapy: CO2 laser, Nd:YAG laser for hair follicle ablation
• Botulinum toxin: Sometimes used to reduce sweating in affected areas

Treatment escalation indicates severity. Being on biologics or having undergone surgery is strong PIP evidence.

Specific Activities and How HS Affects Each

• Activity 1: Standing causes thigh/groin friction. Lifting causes axillary pain. Often descriptor c.
• Activity 4: Showering on open wounds. Need to dry carefully around abscesses. Often descriptor b-d.
• Activity 5: Perianal HS causes severe pain on defecation. Need adapted toileting (commode, wet wipes).
• Activity 6: Tight clothing causes friction. Need loose dark clothing to hide stains. Bras particularly problematic.
• Activity 9: Odour, drainage, embarrassment cause social withdrawal. Descriptor c-d common.
• Activity 11: Cannot travel due to pain, dressing needs, anxiety about leakage.
• Activity 12: Walking causes friction between thighs, on buttocks, in groin. Descriptor b-d possible.

Comorbidities Common with HS

HS has high rates of:

• Metabolic syndrome: Obesity, diabetes, hyperlipidaemia
• PCOS (in women) - commonly found alongside HS
• Inflammatory bowel disease: Crohn's particularly
• Spondyloarthropathy: Inflammatory arthritis
• Depression and anxiety: a large proportion of HS patients
• Pyoderma gangrenosum: Another severe skin condition
• Smoking: Strong association, not causal

List all comorbidities on the form. The combined impact is what scores.

Daily Wound Care - Activity 3 Time

Severe HS wound care can take significant daily time, but Activity 3 only counts the time another person spends supervising, prompting or assisting with prescribed therapy at home. Time you spend doing it alone does not score, and medication and monitoring never score more than 1 point:

• Cleaning wounds (antiseptic): 15-30 min twice daily, counts only if a partner, carer or nurse has to do it or supervise it
• Packing tunnels with gauze: 10-20 min per session, counts on the same basis
• Applying dressings (often multiple types - hydrocolloid, alginate, foam): 15-30 min, prescribed dressings put on by another person can count as therapy time
• Dressing changes after sweating, leakage, exudate: variable, often multiple times daily, again only the helper's time counts
• Antibiotics or biologic injections weekly: medication, so descriptor 3b (1 point) if you need help or an aid with them
• Hospital appointments (dermatology, surgical drainage): not therapy undertaken at home, so useful as evidence but not as hours

Add up the helper's time only. Up to 3.5 hours a week is descriptor 3c (2 points), more than 3.5 up to 7 hours is 3d (4 points), more than 7 up to 14 hours is 3e (6 points) and more than 14 hours is 3f (8 points). For example, 30 minutes of hands-on help with dressings twice a day is 7 hours a week, descriptor 3d.

Frequently Asked Questions

I'm embarrassed to describe my HS on the PIP form. Do I have to?

Yes, and the more detail the better. The assessor needs to understand the reality. "I have open draining wounds in my armpits and groin" is exactly the kind of statement that scores points. Being vague because you're embarrassed means losing points you deserve. Remember, assessors see conditions like this every day - they will not judge you.

My HS flares and then calms down. How do I describe that?

Count the number of days per month you're in a flare. If it's more than 15 days (50%), your flares happen on "most days." Also describe the impact BETWEEN flares: scarring causing ongoing pain, anxiety about the next flare, having to carry spare dressings everywhere.

Will the assessor want to see my HS?

No. The assessor takes the medical evidence and your description. They will not request to examine your wounds. If they did, you have right to refuse.

I am on biologics (adalimumab) - what does this mean for PIP?

NHS biologic eligibility for HS requires Hurley Stage II/III plus failure of standard treatment. Being on biologics is strong evidence of severity. Injection burden and ongoing monitoring count under Activity 3 only as descriptor 3b (1 point) if you need help or an aid with them, so describe biologic side effects under the activities they affect.

I had surgery for HS - am I "cured"?

HS often recurs in new areas or at surgical sites. Many post-surgical patients have ongoing disease in different anatomical areas. Surgery typically reduces but does not eliminate HS in established disease.

How do I describe the smell without being graphic?

Use clinical language: "Active drainage from sinus tracts produces malodorous discharge that requires frequent clothing changes and significantly affects my willingness to engage with others socially."

Should I include the mental health impact separately?

Yes. Get formal depression/anxiety diagnosis from GP or psychiatrist. List as separate condition. HS-related body image and social withdrawal significantly affect Activity 9 - often 4-8 points.