Dresden Davis, a 31-year-old corporate banker and food blogger, grew up with parents who didn’t have much access to doctors, so she and her siblings were adamant about getting everything checked. “If it hurts, we’re going to the doctor.” That was their motto.
While she was in college 12 years ago, experiencing tiny bumps in her groin, Davis thought she had hair bumps from shaving, like most people. She had no idea she’d spend the next decade trying to tackle hidradenitis suppurativa (HS). This inflammatory condition causes lumps and skin lesions to form on the skin due to blocked hair follicles. She had never heard of this condition and doctors didn’t have much knowledge about it (they still don’t). “When I would look online at pictures, it would always be white women, but obviously it looked very different on white skin versus Black skin. For white people, you would just see these red marks on their skin. I would be like well, mine doesn’t look like that. I just have a bump; my skin complexion is the same,” she said. But she knew something was wrong. “I’ve always wanted nice clear underarms, like most Black women and women of color, so it was definitely heartbreaking to have a condition that affected that area. In the summer I felt super self-conscious about wearing tops that would show my underarms or going swimming if I had a bump/sore in my groin,” she said. Thankfully she was always surrounded by support from friends to men she dated during the height of her flare-ups who never judged her about her.
It took her about four to six months to go to her primary care physician. After immediately diagnosing her with HS, they told her the same thing most doctors say: “Just lose weight.” Even after losing 50 pounds, that wasn’t the simple answer to her skin condition. It took her years of trialing dermatologists, over-the-counter medications and surgical procedures until she finally found a specialist who understood her condition better and tackled it with a few surgeries, very expensive surgeries. Here, her decade-long process of fixing her HS and what she does to maintain her skin now.
First, there were a lot of dermatologist appointments and prescriptions.
After her primary-care physician was dismissive, she felt helpless. “The bumps would go away eventually, but they’d come right back,” she said. About a year later, she turned to a dermatologist who made the condition seem pretty common. The first dermatologist prescribed her Clindamycin gel, a topical antibiotic normally prescribed to help control acne. She was told to put the gel on whenever a bump appeared but that did nothing so she went to get another dermatologist a few months later. This time she went with all of her notes with what her physician was telling her and what the last dermatologist prescribed.
Her new dermatologist prescribed her something completely different, Doxycycline, another antibiotic, this time an oral one, used to treat bacterial infections, it’s also known to treat rosacea and severe acne. She was told to take it whenever she got a bump. She did that for months and saw no changes.
Price: Covered by insurance
Verdict: It didn’t work … at all
Then, she got plastic surgery
After failed dermatologist attempts, she went back to her physician a year later who wanted to go another route: surgery. “I basically got a bump under my arm and usually they would come to the bump, it would pus up or bleed and it would heal, but this one did not heal for months,” she said. This bump created an open sore that wasn’t painful but it was just open skin. Even though it didn’t look infected she knew she had to do something about it. Essentially the surgery was stitching up and pulling her skin together so it wouldn’t open. “That was my first official surgery. I had to go under anesthesia and it was in a plastic surgeon’s office.” That healed it up, for the time being.
Price: Covered by insurance
Verdict: It was a temporary Band-Aid over the condition.
She started going to urgent care … a lot
From 2014 to 2019, the bumps were still pretty frequent. She was away at college and remembers having a bump that was severely painful and her parents recommended going to urgent care. They didn’t know much about HS, but they knew how to tackle bumps growing under the skin, so they’d pop them for her. “That became … I don’t want to say a habit, but a lot of times when it hurts doctors just gave me medicine and I wanted the bumps to actually go away,” she said. Those visits would have a copay of $15-20, which she admits is probably why she kept doing it, but she was also “super embarrassed and ashamed” going because she was in college and no one around her was having the same issues. Davis was away at school on her parents’ insurance and didn’t have a doctor there so paying $20 out of pocket.
Price: A couple of hundred dollars per year
Verdict: The bumps kept coming, but it put an immediate stop to the pain.
She tried waxing instead of shaving
During those urgent-care years, she remembers being advised by a dermatologist to stop shaving because it could be irritating her HS and to start getting waxes. So she would cycle her urgent-care appointments with her waxing appointments. In 2016 her strict waxing regimen started. “I was lucky enough to find estheticians who may not have known much about HS, but they cared about my skin,” she said. So if she was having a flare-up or in pain, they were always very gentle and never turned her away. Since then, she’s been getting a wax for $90 a session every four weeks.
Price: $90 per month
Verdict: It was tackling getting rid of ingrown hairs at the root, but her flare-ups didn’t stop.
She tried laser hair removal
In January 2020 she found a medspa, but she was too scared to try laser hair removal treatments on her groin area because of horror stories she’d heard of people getting scars. “I already had HS scars so I didn’t want to make that any worse,” Davis said. She paid $1,000 for an eight pack session and eventually added on two additional sessions, she just tried it on her underarms. “I had twelve sessions of laser and the hair was still growing back.” She does note that when the Covid lockdown started she went about three months without it so she lacked consistency at the start of her laser journey. “They told me it wasn’t a permanent solution so depending upon my genetic makeup and hormones, the hair could grow back.” That’s precisely what it did; to this day, it grows back normally.
Price: $1,500
Verdict: It didn’t work and it was extremely painful.
She found the right specialist and underwent $6,600 worth of surgery
In April 2020, she finally got off the waitlist and was able to see the HS specialist, Dr. Christopher Sayed. “I love that man. That was my first appointment, and I felt like somebody really sat down to listen to me and my issues with HS. I think it helped that he only really sees patients with HS,” she said. The first time she saw him she had a flare up and he gave her a steroid shot, it was her first time having one and he told her he was going to schedule her for skin unroofing surgeries, an invasive surgery where he goes under the skin to clear the track and take the skin completely out. HS flare ups occur in the same exact spots every time they have to tackle the root under that part of the skin.
Her first surgery was in June 2020 (her groin and one underarm), her second was in March 2021 (her groin and one underarm again) and her final one was in March 2022 (both underarms). During each surgery, she was awake and she remembers him numbing the area before making incisions to take the skin out. They kept all of her healthy skin for research since doctors are still trying to figure out how to cure HS. “I’ve had tiny flares but I really haven’t had a huge flare-up since then. That’s where all my money went.”
Price: $6,600
Verdict: It worked, finally.
How she’s maintaining post-surgery:
Dr. Sayed recommended doing laser after her surgeries to help with the hair growth. He tried to bill it to her insurance, but they considered it cosmetic. She couldn’t keep up the cost so after four $386 laser sessions, she had to stop.
Price: $1,544
Verdict: It worked with the surgery but wasn’t necessary.
She has to go see Dr. Sayed once every three years. The last time she saw him, she had no HS flare-ups, but she did start randomly getting adult acne and he was a huge help for that, too. Now at 31-years-old, she hasn’t had a flare-up form since then but she keeps up with monthly waxes. “Having more knowledge of the condition, it doesn’t affect me mentally as much anymore. Finding someone with perfect, flawless skin is basically impossible.”
She finds that her underarms look best when exfoliating and waxing regularly, so she uses a dry brush to exfoliate. Dry brush bristles are often a bit soft and they remove a layer of dead skin cells.
To prevent ingrown hairs, which could irritate her HS, she uses Topicals High Roller hair tonic, a cult favorite. The AHA and BHA serum in a roll-on uses Zina PCA, salicylic acid and glycolic acid to penetrate the pores and decrease and build up that may cause ingrowns.
She still hasn’t found anything effective for her scarring. “I have some not so pleasant scars from the surgeries.” She’s been trying Mederma’s PM intensive overnight scar cream, a dermatologist-recommended cream that penetrates the skin to renew skin cells and target scars and marks, but she hasn’t seen noticeable results yet.
Price: $225, including her monthly wax appointments
Verdict: This routine is working for her.