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Symptoms – Itching

Many people with hidradenitis suppurativa (HS) consider itching one of the most troublesome symptoms of the disease. In most cases, only pain and discharge of pus are worse.1

HS is a painful, chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. The process leads to:2

  • Abscesses
  • Pus
  • Odor
  • Inflammation
  • Tunnels under the skin
  • Scars

Sporadic flares worsen pain and discharge of pus.3

How common is itching in HS?

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 from 12 to 48 hours before bumps appear.4

According to a 2017 study in the Netherlands, more than 50 percent of people with HS reported itching. A 2018 research study in Poland showed that about 42 percent of people with HS reported itching.1,5

The Polish study found that about 33 percent of people with HS experienced itching every day. Another 33 percent experienced itching a few times a week, while another 33 percent experienced itching a few times a month.5

The itching usually lasted about 10 minutes at a time. It occurred most often during the evening. The most common locations for itching were the buttocks and the armpits.5

How bad is the itching?

In the Polish and Dutch research studies, just over half of people with HS itching rated it as moderate.1,5

People with higher levels of itching also had more pain, more affected body areas, and more severe disease. People who smoked complained more about itching.5

The most common factors that increased itching included:1

  • Sweating
  • Heat
  • Physical activity
  • Hot water

No factors were found that reduce the intensity of itching.1

How does itching affect people with HS?

More than 66 percent of people with HS itching said that itching sometimes affected their sleep. Both itching and pain have been found to increase insomnia and reduce sleep quality in people with HS.5,6

More than 50 percent of people with HS itching said it impaired activities of daily living, including:5

  • Leisure and social activities
  • Housework
  • Errands
  • Work
  • School

Itching can cause people with HS to isolate themselves from friends and cause them to cancel work appointments.7

Along with pain, odor, and scars, people with HS say itching is a cause of:7

  • Irritation
  • Anger
  • Sadness
  • Worry
  • Depression

Increases in itching, pain, and sick days are related to more feelings of depression and a lower quality of life.8

What causes itching?

Researchers have described or suggested several causes for the itching in HS, including:1,5,9-12

  • Mast cells in lesions (sores) and the skin around lesions. Mast cells release histamine, which can cause itching and other allergic symptoms.
  • Irritation of nerves caused by scar formation.
  • Side effects of medicines. The antibiotic clindamycin applied to the skin and oral retinoids (vitamin A-based medications) can relieve HS symptoms, but each can cause itching.

More research is needed to better understand the role that itching plays in HS. Awareness of uncertainties about the causes of itching and ways to reduce it may encourage more research to help people with HS improve their quality of life.

Written by: Ina Fried | Last reviewed: December 2020
  1. Matusiak L, Szczech J, Kaaz K, et al. Clinical characteristics of pruritis and pain in patients with hidradenitis suppurativa. Acta Derm Venereol. 2018 Feb 7; 98(2):191-194. doi:10.2340/00015555-2815.
  2. 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.
  3. Jemec GBE. Clinical practice: Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi/full/10.1056/NEJMcp1014163.
  4. Danby FW, Margesson LJ. Hidradenitis suppurativa. Dermatol Clin 28. 2010;779-793 doi:10.1016/j.det.2010.07.003 0733-8635/10/$.
  5. Vossen ARJV, Schoenmakers A, van Straalen KR, et al. Assessing pruritus in hidradenitis suppurativa: a cross-sectional study. Am J Clin Dermatol. 2017;18:687-695. doi:10.1007/s40257-017-0280-2.
  6. Kaaz K, Szepietowski JC, Matusiak L. Influence of itch and pain on sleep quality in patients with hidradenitis suppurativa. Acta Derm Venereol. 2018 Aug 29;98(8):757-761. doi:10.2340/00015555-2967.
  7. Esmann S, Jemec GBE. Psychosocial impact of hidradenitis suppurativa: a qualitative study. Acta Derm Venereol. 2011;91:328-332. doi:10.2340/00015555-1082.
  8. Onderdijk AJ, Van der Zeek HH, Esmann S, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2013;27:473-478. doi:10.1111/j.1468-3083.2012.04468.x.
  9. Van der Zee HH, de Ruiter L, Boer J, et al. Alterations in leucocyte subsets and histomorphology in normal-appearing perilesional skin, early, and chronic hidradenitis suppurativa lesions. Br J Dermatol. 2012;166:98-106. doi:10.1111/j.13645-2133.2011.10643.x.
  10. Henochowicz SI. Histamine is released. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/ency/imagepages/19333.htm. Accessed 7/24/2020.
  11. Nesbitt E, Clements S, Driscoll M. A concise clinician’s guide to therapy for hidradenitis suppurativa. Int J Womens Dermatol. 2020 Mar;6(2):80-84. Epub 2019 Dec 27. doi:10.1016/j.ijwd.2019.11.004.
  12. Hidradenitis suppurativa (HS): retinoids. National Health Service. Available at https://www.nhs.uk/conditions/hidradenitis-suppurativa/. Accessed 7/29/2020.