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Hidradenitis Suppurativa (HS) on the Neck: What To Know

Posted on May 03, 2022
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Imee Williams

Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, inflammatory skin disease. People who have HS develop painful, acne-like lesions or cysts under the skin. HS lumps most commonly occur under the arms, in the groin area, between the buttocks, and under the breasts. In rare cases, HS can affect the neck.

If you have HS on your neck, you are not alone. More than 780 members on myHSteam report HS symptoms on the neck. “I get an average of three new painful boils on my neck every week,” shared one member. “My body is full of scars, dark spots, and craters.”

The good news is that HS is more treatable than ever, and several newer, effective options are available. It is important to begin treatment early to help improve your overall quality of life.

Symptoms of HS on the Neck

HS usually occurs in places of the body that have a lot of sweat glands. Researchers believe that HS on the neck may instead be associated with hair follicles. However, more studies are needed to fully understand this association.

Early signs and symptoms of HS on the neck include folliculitis (inflamed hair follicles), which eventually develops into deep lesions under the skin. Symptoms like itching, pain, stinging, or burning may occur 12 to 48 hours before a lesion appears.

HS lesions can appear on the nape of the neck (the back of the neck where hair begins to grow), the back of the neck, and the front of the neck. They can last for weeks or months. Lesions can look like deep, pea-sized bumps, similar to acne cysts or boils. Some skin lesions can grow and burst, draining foul-smelling pus. Over time, skin lesions may leave rope-like, raised scars and form tunnels under the skin that connect with each other. Skin lesions can also be recurrent, disappearing and then reappearing over time.

Doctors use the Hurley staging system to assess HS severity. Milder HS is classified as stage 1. Moderate HS is classified as stage 2, while severe HS is classified as stage 3.

HS symptoms can be triggered or worsened by smoking, changes in the menstrual cycle, stress, excessive sweating, or weight gain.

Treating HS on the Neck

Although there is currently no cure for HS, several treatment options can improve your symptoms and reduce new lesions. Your dermatologist will help create a treatment plan based on where your lesions occur and the severity of your HS.

Treatments for HS can include medication rubbed into the skin, injected directly into HS lesions, taken by mouth, or injected subcutaneously (under the skin). Corticosteroids are one type of medication used for HS. These drugs suppress inflammation by suppressing the immune system.

“My dermatologist used steroid injections directly into the cysts/boils on my neck, which helped them go away,” shared one myHSteam member.

One case study found that HS on the neck responds best to tumor necrosis (TNF)-alpha inhibitors. These are biologic medications that are injected under the skin. “I went on a TNF-alpha inhibitor three months ago, and it put me into nearly full remission,” wrote one myHSteam member who reported HS lesions on their neck.

Other therapies such as laser hair removal, radiation therapy, and surgical treatments to remove damaged tissue may improve moderate to severe HS. Laser hair removal may also benefit people with mild HS.

Read more about treatments for HS.

Managing HS Symptoms on the Neck

Several risk factors are associated with the development of HS. Changing certain lifestyle habits or adopting new ones — quitting smoking, exercising daily, and eating a healthy diet, for example — may also help control your HS.

Weight Loss

Studies have found that being overweight or obese is a risk factor for developing HS. People who are overweight or obese tend to sweat more, have higher levels of inflammation throughout their body, and have more skin irritation due to more friction on their body. Reaching and maintaining a healthy weight can reduce your risk of an HS flare-up or worsening symptoms.

A small study of people who underwent bariatric bypass surgery found that people with HS who lost 15 percent or more of their body weight reported significant improvements in their HS symptoms. About 50 percent reported no HS symptoms after losing weight, and about 20 percent reported fewer active lesion sites.

Smoking

Smoking cigarettes is also associated with HS. Researchers have found that 70 percent to 90 percent of people who develop HS also smoke. Quitting smoking can help prevent worsening HS symptoms and reduce your risk of flare-ups.

Diet

What you eat may affect your HS. Some foods may trigger flare-ups, and others can help prevent them. A few small studies have found that avoiding certain foods — dairy, carbohydrates, and sugar, among others — may lessen flare-ups and sometimes clear HS.

Some dermatologists have reported improvements in some patients with HS when they followed a Mediterranean diet or a plant-based diet. It is important to first speak to your dermatologist or primary care provider before changing your diet.

Read more about how diet can help with HS symptoms.

At-Home Recommendations

In the early stages of HS, you may be able to manage your flare-ups by following these at-home tips:

  • Avoid using harsh products on the skin.
  • Avoid using cleaning tools such as loofahs and brushes to scrub the skin.
  • Don’t shave near breakouts on the neck.
  • Clean your neck daily with an antibacterial soap or cleanser.
  • Wear loose-fitting clothing to prevent rubbing or friction against the skin.
  • Use a warm compress or heating pad on painful bumps for 10 minutes at a time.
  • Keep your skin cool and dry.

Some myHSteam members also shared their at-home tips:

  • “Use hot packs and hot baths.”
  • “Stop wearing makeup to cover up your abscesses.”
  • “Stop using scented body washes and lotions, perfumes, and body sprays.”
  • “Use honey pads on open flares.”
  • “Bleach baths have helped me so much!”
  • “Figure out what foods, drinks, or stresses make your skin flare up.”
  • “I apply benzoyl peroxide on my lesions at night and wash my face and neck with an antibacterial cleanser.”

Speak with your dermatologist about the best options for your HS before making any lifestyle changes or trying the at-home recommendations mentioned above.

Talk With Others Who Understand

Living with HS can be difficult, but you aren’t alone. On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 24,500 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Do you have HS on your neck? What have you found to soothe HS neck symptoms? Share your thoughts in the comments below or by posting on myHSteam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Imee Williams is a freelance writer and Fulbright scholar, with a B.S. in neuroscience from Washington State University. Learn more about her here.

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