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Symptoms of Hidradenitis Suppurativa

The first symptom of hidradenitis suppurativa (HS) is a bump. However, that is not the only symptom of this painful, chronic inflammatory skin disease. Other symptoms include:1

  • Pain
  • Itching
  • Odor
  • Infection
  • Scarring

What areas are affected by HS?

The armpit is the most common location of HS bumps. In order of most common to least common, other areas affected by HS include:1

  • The groin (the folds where the abdomen joins the legs)
  • Area around the anus and between the anus and the genitals
  • Breasts and under the breasts
  • Buttocks
  • Pubic area
  • Chest
  • Scalp
  • Behind the ears
  • On the eyelids

Bumps and lumps

HS begins when clogged hair follicles cause small, tender, round bumps under the skin. They usually appear in an even pattern on both sides of the body. These boils or pimples last 7 to 15 days. Then they come and go in sporadic flares.2,3

Different types of bumps and lumps may appear. They include:2,4,5

  • Comedones – skin-colored bumps that result when skin cells, bacteria, and oil block hair follicles
  • Papules – solid bumps up to 1 centimeter (less than half an inch) wide
  • Pustules – bumps that contain pus
  • Abscesses – painful, swollen lumps filled with pus. The hair follicles burst, causing deep abscesses in the thick layer of skin below the surface. As the pus spills out, it causes inflammation.
  • Sinus tracts – narrow tunnels extending under the skin and sometimes connecting the bumps. These sinus tracts have nothing to do with the nasal sinuses in your head. Repeated clogging and bursting of hair follicles lead to formation of sinus tracts that drain pus.

Pain

Most people with HS consider pain as one of the worst symptoms of the disease. Pain can be acute or chronic:6

  • Acute pain is a burning, stinging, shooting, or stabbing sensation that comes from inflamed lesions (sores). It may send people with HS to the emergency room for relief.
  • Chronic pain is an ongoing aching and throbbing, especially from advanced disease.

Either type of pain can interfere with sleep and activities of daily life. Medications prescribed by your dermatologist (skin specialist), home remedies, and alternative medicine can help relieve moderate pain. For severe pain, your dermatologist may work with a pain management specialist to create an effective treatment plan for you.6

Itching

The onset of HS usually comes with small red bumps. The bumps may have some itching or pain. Up to half of people with HS report early symptoms of burning, stinging pain, and itching about 12 to 48 hours before bumps appear.7

Infection

Most researchers agree that bacterial infection is not the main cause of HS. Bacteria invade HS lesions and sinus tracts. They make the disease worse, increase pus, cause odor, and enlarge lesions.5,8

It is extremely rare for infections to cause septicemia in people with HS. Septicemia is a serious, sometimes fatal, infection in the bloodstream.4,8

Scarring

As HS bumps heal, they leave raised scars. Sinus tracts may develop dense, ropelike scars that crisscross an area that was inflamed.7

In addition to their appearance, the scars may cause other problems. They may result in contractures. These are permanent tightening of muscles, tendons, skin, and other tissues that prevent normal movement. If you have contractures, you may not be able to lift your arms or separate your thighs, leaving you disabled.4,7

There is hope for people with HS

Treatment options can reduce symptoms, relieve pain, and heal lumps and bumps. An experienced dermatologist can work with a team of healthcare professionals to improve your symptoms and quality of life.

Written by: Ina Fried | Last reviewed: December 2020
  1. Slade DEM, Powell BW, Mortimer PS. Hidradenitis suppurativa: pathogenesis and management. British Association of Plastic Surgeons. 2003;56:451-461. doi.org/10.1016/S0007-1226(03)00177-2.
  2. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105‐115. doi:10.2147/CCID.S111019.eCollection 2017.
  3. What is hidradenitis suppurativa? Hidradenitis Suppurativa Foundation. Available at https://www.hs-foundation.org/what-is-hs/. Accessed 7/17/2020.
  4. Dermatology glossary of terms. DermNet NZ. Available at https://www.dermnetnz.org/glossary/. Accessed 7/17/2020.
  5. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  6. Patel ZS, Hoffman LK, Buse DC, et al. Pain, psychological comorbidities, disability, and impaired quality of life in hidradenitis suppurativa. Curr Pain Headache Rep. 2017;21(12):49. doi:10.1007/s11916-017-0647-3.
  7. Danby FW, Margesson LJ. Hidradenitis suppurativa. Dermatol Clin 28. 2010;779-793 doi:10.1016/j.det.2010.07.003 0733-8635/10/$.
  8. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28:1013-1027. doi.org/10.1016/j.bpobgyn.2014.07.012.