A 29-year-old woman presents to the dermatology clinic with a five-year history of painful, recurrent boils in both armpits. The lesions start as small, tender lumps and then progress to large, deep nodules that sometimes rupture and drain foul-smelling pus. Over time, she has noticed scarring and skin thickening in the affected areas.

She reports that the flare-ups worsen before her menstrual cycle and that she has had similar painful bumps in the groin area in the past. She denies any fever but notes difficulty raising her arms due to pain. Her medical history is unremarkable, though her mother had similar skin issues. She smokes regularly and is overweight.

On examination, both axillae show multiple inflamed nodules, draining sinus tracts, and thickened scar tissue. There is no active bacterial infection, but the lesions appear deep and chronic. A diagnosis of hidradenitis suppurativa (HS) is made.

The patient is advised to quit smoking, lose weight, and avoid tight clothing. She is started on topical clindamycin and oral antibiotics (doxycycline) for inflammation control, with consideration for biologic therapy (adalimumab) if symptoms persist. She is educated about long-term management, including lifestyle modifications and early treatment of new flare-ups.