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Hidradenitis Suppurativa Stage 1: Pictures and Treatment

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Imee Williams
Posted on December 27, 2021

Hidradenitis suppurativa (HS), also called acne inversa, is an inflammatory skin condition that affects at least 1 in 100 people. HS can be classified into three stages of severity using the Hurley staging system. Hurley stage 1 is the mildest form of HS, and about 68 percent of people with HS fall in this category.

People with stage 1 HS often don’t have any symptoms, and treatments often lead to good outcomes.

What Is Stage 1 Hidradenitis Suppurativa?

HS is known to begin at the hair follicle, where inflammation causes painful red nodules, boils, or abscesses within the armpits, groin or genital area, thighs, and buttocks. HS may also sometimes affect the face, neck, area behind the ears, abdominal fold area, and skin under the breasts. HS is noncontagious and is not sexually transmitted or caused by poor hygiene.

In 1989, the Hurley staging system was created and has since become the gold standard for diagnosing and predicting outcomes for HS. The stages include:

  • Stage 1, which involves one lesion or isolated abscesses without scarring or sinus tract formation (narrow openings developing underneath the skin)
  • Stage 2, which involves recurrent abscesses with widely separated lesions, sinus tract formation, and scarring
  • Stage 3, which involves multiple interconnected sinus tracts, abscesses, and extensive scarring

Stage 1 HS is the mildest and most easily treated form of HS. Stage 1 HS lesions appear as blackheads or small pea-sized bumps that are sometimes mistaken as acne, boils, ingrown hairs, or herpes. The lesions appear in areas of the body where the skin rubs together or where there are certain sweat glands called apocrine sweat glands. The most common locations include the armpits, groin, buttocks, and breasts.

The onset of stage 1 HS generally begins after puberty, and mild HS is often diagnosed between the ages of 20 and 24 years. HS is seen in women more than twice as often as in men. In the United States, HS is more prevalent among Black people than other members of other racial or ethnic groups.

About two-thirds of people with HS will never progress past stage 1. However, if left untreated, some people’s symptoms will progress into severe hidradenitis suppurativa.

Symptoms and Pictures of Stage 1 Hidradenitis Suppurativa

The early signs and symptoms of stage 1 HS vary from person to person, and some people may not have symptoms. Stage 1 HS lesions can present as painful, pea-sized, red lumps under the skin. They also can appear as blackheads, also known as double-ended pseudocomedones or double-barreled blackheads. In this stage, lesions can last for weeks to months and scarring does not typically occur.

Painful, pea-sized lumps can be an early symptom of HS. They tend to develop in one place on the body. (DermNet NZ)
Double-ended pseudocomedones appear as blackheads and tend to develop in pairs. (DermNet NZ)

Some possible early symptoms of stage 1 HS include:

  • Mild discomfort, burning, itchy skin, or excessive sweating in area of skin
  • Noninflammatory nodules
  • Fewer than five inflammatory nodules
  • A single painful bump in an area of the body typically impacted by HS
  • A single painful bump that disappears after a few weeks, but then reappears
  • Tender, swollen, or discolored patches of skin under the arms, in the groin, around the buttocks, or under the breasts

Early detection is key to managing stage 1 HS in the long term. If you notice abscesses in the common areas, you should bring the bumps to the attention of your doctor immediately. In addition, take note of any changes in abscesses such as enlargement or darkening of the area.

This person had what looked like two ingrown hairs but turned out to be symptoms of stage 1 hidradenitis suppurativa. (Diverse Stock Photos)

Treatments for Stage 1 Hidradenitis Suppurativa

There is no cure for HS, but many treatments are available that can help you manage your symptoms. The treatment options that dermatologists recommend are partly based on stage. Other factors may also be considered, including:

  • The severity of symptoms
  • The number of lesions
  • Your general health and medical history

Stage 1 HS is the most easily treated stage of HS. It can often be treated with topical (applied to the skin) clindamycin, an antibiotic that helps reduce inflammatory lesions. Nonsteroidal anti-inflammatory drugs (NSAIDS) — such as ibuprofen — or over-the-counter pain relievers can be used to treat both pain and inflammation. Oral contraceptive pills may benefit someone experiencing flare-ups before their menstrual cycle.

In some cases, corticosteroid injections may be used to treat early painful nodules that are not infected and to reduce inflammation. Laser hair removal is another option to treat mild HS. This treatment helps reduce the number of hair follicles on the skin and may help reduce the number of lesions over time. Most people with stage 1 HS will need three to six laser hair removal sessions to notice improvements.

Doctors may sometimes recommend topical antiseptic washes, such as 4-percent chlorhexidine or benzoyl peroxide to keep the area of skin clean and reduce the risk of infection.

Home Remedies

Other ways to treat stage 1 HS lesions at home include:

  • Applying a warm compress on the area of the skin for a few minutes
  • Wearing loose-fitting undergarments and clothing to minimize friction
  • Using antibacterial soap on the affected area of skin
  • Avoiding skin care products that irritate the skin
  • Avoiding shaving affected areas, such as the underarms
  • Minimizing heat exposure and sweating
  • Keeping the area of skin dry and cool

Managing Stage 1 Hidradenitis Suppurativa

The impact of HS on a person’s quality of life can be profound. However, stage 1 HS often leads to good outcomes and can often be easily managed through healthy lifestyle changes.

Weight Loss

Like HS, obesity also contributes to inflammation. There is a strong association between increasing body mass index (BMI) and the increasing severity of HS. Weight loss or healthy weight management may reduce your risk of flare-ups or of progressing to more severe HS.

Quitting Smoking

The link between smoking and HS has been well studied. Smoking tobacco can increase inflammation throughout the body, worsening HS symptoms. Studies have found that most people with HS actively smoke. If you smoke, quitting may reduce your risk of HS flare-ups. Read more about hidradenitis suppurativa and smoking.

Diet

Certain foods and stress can trigger an HS flare-up in some people. The Mayo Clinic recommends people with HS eliminate dairy products, reduce sugar consumption, and avoid brewer’s yeast. Changing your diet may also be a helpful and healthy way to lose weight.

Talk With Others Who Understand

Living with HS can be difficult, but you are not alone. On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 23,000 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Do you have stage 1 hidradenitis suppurativa? What treatments work for you? Share your thoughts in the comments below or by posting on myHSteam.

References
  1. Hidradenitis Suppurativa — MedlinePlus
  2. Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States — JAMA Dermatology
  3. European S1 Guideline for the Treatment of Hidradenitis Suppurativa/Acne Inversa — Journal of The European Academy of Dermatology and Venereology
  4. What Is Hidradenitis Suppurativa? — Canadian Family Physician
  5. Inflamed/Infected Sweat Glands (Hidradenitis) — John Hopkins Medicine
  6. Inter- and Intrarater Reliability of Hurley Staging for Hidradenitis Suppurativa — The British Journal of Dermatology
  7. A Retrospective Study of the Characteristics of Patients With Early-Onset Compared to Adult-Onset Hidradenitis Suppurativa — International Journal of Dermatology
  8. Hidradenitis Suppurativa — Mayo Clinic
  9. Special Considerations for Women With Hidradenitis Suppurativa — International Journal of Women’s Dermatology
  10. Hidradenitis Suppurativa — Known and Unknown Disease — Reumatologia
  11. Double-Ended Pseudocomedones in Hidradenitis Suppurativa: Clinical, Dermoscopic, and Histopathological Correlation — Acta Dermato-Venereologica
  12. Hidradenitis Suppurativa: Diagnosis and Treatment — American Academy of Dermatology Association
  13. The Hurley and Sartorius Systems: Two Methods of Staging HS — Consultant360
  14. Hidradenitis Suppurativa (HS) — NHS
  15. Hidradenitis Suppurativa: A Common and Burdensome, Yet Under-Recognised, Inflammatory Skin Disease — Postgraduate Medical Journal
  16. Impact of Smoking Status on Remission in Hidradenitis Suppurativa — American College of Rheumatology
  17. Hidradenitis Suppurativa and Diet: What’s Recommended? — Mayo Clinic
  18. Clindamycin as Unique Antibiotic Choice in Hidradenitis Suppurativa — Dermatologic Therapy
Posted on December 27, 2021
All updates must be accompanied by text or a picture.

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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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