Hidradenitis suppurativa (HS) can affect any patch of skin with hair follicles. Behind the ear isn’t a commonly affected area, but sometimes HS symptoms can pop up in unexpected places. Several myHSteam members have mentioned symptoms on the face, neck, ear, and scalp. “I have had stuff behind my ear I wondered about,” wrote a member of myHSteam. Another shared, “Every now and again, I get a painful and large cystic bump behind my ear. It seems similar to a typical minor HS boil.”

A nodule or abscess behind your ear may or may not be related to HS. Other skin conditions can cause similar symptoms in this area. Here are some potential issues to discuss with your health care provider to help get to the root of the problem.

How HS Develops in Different Areas

Inflammation and blockage in the hair follicles cause HS, so symptoms can develop pretty much anywhere on the body. Humans are born with more than 5 million hair follicles, which are tubelike pores in the top two skin layers. Aside from serving as the site of hair growth, hair follicles also help repair wounded skin and form new blood vessels and neurons.

The most common areas affected by HS are the armpit, groin, buttocks, and breast, especially where there’s sweat or the skin rubs together.

Some different types of HS lesions include blackheads (usually more than one), painful pea-sized lumps under the skin, and leaking sores that eventually break open.

Hormones, genetics, family history, and risk factors (like smoking) contribute to HS.

Members of myHSteam have had flare-ups behind their ears and on other parts of the face and neck. “My 16-year-old son would get really large ones on his face, back, chest, everywhere you could possibly imagine,” explained one member. “He would get large painful boils and cysts, and it was multiple at a time. He has a lot of facial hair for his age, and he could never shave because it would cause more to form.”

Another member shared, “I’ve not had them on the front of my face, but I get them on my neck and ears and under my chin.”

How HS Behind the Ear Can Affect Daily Life

Like other HS symptoms, lesions behind the ear can be painful and produce an off-putting odor. You may feel self-conscious about what others think if your HS is visible. Depending on your sleep position, a painful HS lump behind your ear can make it difficult to get a restful night’s sleep.

Perhaps one of the more frustrating aspects of getting HS in less common parts of the body is the potential for misdiagnosis or misunderstandings at the doctor’s office. “Sadly, many doctors don’t realize that HS can be anywhere on your body. They think it is only going to be in your groin or under your arms,” said one myHSteam member. “You can’t see any scars, but I had to have my ear lobe removed from my face because of HS! It tries to come back periodically, and it drains through my ear piercing.”

Other Possible Behind-the-Ear Issues

HS isn’t the only potential cause of cysts or pimples behind the ear. A benign ear cyst is a noncancerous growth. Dead skin cells and skin oils can produce these cysts behind the ear, on the earlobe, or inside the ear. They usually develop slowly and may resolve without treatment. However, if the cyst becomes painful or infected, you should seek medical care.

If the lump develops on a part of your ear where you had a piercing, it might be a keloid. Keloids are caused by scarring. If you have a keloid surgically removed, it may return, which makes these growths notoriously difficult to treat.

Sometimes people develop soft, fatty tissue growths called lipomas behind their ears. They’re generally harmless and don’t require treatment.

In rare cases, a lump behind the ear could be cancer-related. But more common causes are swollen lymph nodes from an infection, such as an ear infection, dental infection, or a cold. Untreated ear infections can lead to bacterial infections of the mastoid bone, which is behind the ear. Adults can get ear infections, but they’re more common in children.

Treatment for HS Behind the Ear

You can apply lidocaine cream or ice packs to reduce mild pain from HS behind the ear. Antiseptic wash can help reduce discomfort, too. But if a breakout is severe, you may need topical or oral antibiotics or surgery. “Just had lesions behind my ear removed yesterday because they were forming tunnels up the back of my ear,” shared a myHSteam member.

For HS lesions that produce an unpleasant smell, dermatologists suggest soaking a clean washcloth in diluted white vinegar and dabbing it on the wound to reduce odor.

Surgical excision isn’t usually the first choice for HS treatment, but sometimes it’s necessary. Ideally, you can gain control over flare-ups with treatments like steroids or biologics. You can ask your doctor if a corticosteroid injection could help with noninfected wounds or if laser surgery would benefit areas with recurrent HS symptoms. Discussing any new or worsening symptoms with your dermatologist can help you find the best treatment option.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 34,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

What are your most commonly affected areas with HS? Does HS impact the area behind your ear, and if so, how does this affect your quality of life? Share your experience in the comments below, or start a conversation by posting on your Activities page.