Hidradenitis suppurativa (HS), also called acne inversa, is an inflammatory skin condition that causes painful bumps — typically in the armpits, groin, buttocks, and the underside of the breasts. In stage 3 HS, there are recurring nodules (pus-filled lumps) and abscesses, interconnected tunnels (or sinus tracts), and severe scarring across large areas of the body. Stage 3 HS is less common and, by some estimates, affects about 1 percent of people living with HS.
HS begins at the hair follicle, where inflammation causes painful discolored 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 not contagious. It is not sexually transmitted nor caused by poor hygiene.
The severity and development of HS are classified by three stages using the Hurley staging system. (Stages are sometimes referred to using Roman numerals, e.g., stage II instead of stage 2.)
In stage 3, new nodules and abscesses form as soon as older ones have healed, either in the same or new areas of the skin. Over time, this causes significant scarring, interconnected tunnel formation, and widespread inflammation.
Although the cause of HS remains unknown, certain risk factors are associated with its development. These risks include:
HS triggers include excessive sweat, heat, stress, fatigue, wearing tight clothing, and hormonal changes during the menstrual cycle in some women.
Stage 3 HS lesions appear at new sites or reappear near or on the same spot as the initial lesion. HS lesions affect areas of the body with many lymph nodes and apocrine sweat glands (including armpits, groin, buttocks, and below the breasts). However, as HS progresses to stage 3, areas of the body where the skin repeatedly rubs together are affected, such as the nape of the neck, torso, waistband (or abdominal fold), perianal (around the anus), and thighs. In rare cases, HS lesions can also appear on the face.
Stage 3 HS lesions are large and inflamed boil-like lumps filled with foul-smelling pus. In stage 3 HS, narrow channels called sinus tracts form under the skin and break out on the surface, leaking pus and fluid. Multiple areas of HS lesions become interconnected under the skin by sinus tracts, leading to widespread inflammation.
Stage 3 HS lesions cause severe scar tissue formation and wounds that leak. Scar tissue can interfere with the lymphatic system and cause swelling in the arms, legs, or genitals. Some HS lesions may become infected with bacteria, causing an infection.
Stage 3 HS symptoms are more severe than those of stage 2 HS. Nodules and abscesses commonly reappear more than two times every six months. Although signs and symptoms of stage 3 HS may vary from person to person depending on the area of skin affected, the most common symptoms reported include:
Stage 3 HS can also lead to severe infections on affected areas of the skin.
Additionally, studies have found that the negative stigma associated with HS has a substantial emotional impact on individuals and may increase the risk of depression, social isolation, and poor self-esteem. About 42.9 percent of people living with HS are diagnosed with depression.
There is no cure for HS, but many treatments available can help you manage your symptoms. Dermatologists recommend treatments based on the stage of HS. Other factors, including the severity of symptoms, the number of lesions, and the person’s general health and medical history, are also considered.
Stage 3 HS is treated with a combination of medications and therapies, including:
Surgical treatments are needed if multiple medical therapies have failed. They include:
Other ways to treat stage 3 HS lesions at home include:
Living with stage 3 HS is challenging. This inflammatory skin disease has a profound effect on a person’s quality of life, specifically on their mental and social health. However, some lifestyle changes may help manage or relieve symptoms for some individuals.
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 are active smokers and have higher disease severity. By quitting smoking, you may reduce your risk of HS flare-ups.
Read more about hidradenitis suppurativa and smoking.
Certain foods and stress can trigger a flare-up in some people. The Mayo Clinic recommends that people with HS eliminate dairy products, reduce sugar, and avoid brewer’s yeast. Changing your diet may also be a helpful and healthy way to lose weight.
Read more about diet and hidradenitis suppurativa.
There is a strong association between increasing body mass index (BMI) and the increasing severity of HS. Weight loss or managing a healthy weight may reduce your risk of recurrent lesions (or flare-ups) or worsening the progression of HS.
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 23,500 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.
Do you have stage 3 hidradenitis suppurativa? What advice do you have for others? Share your thoughts in the comments below or by posting on myHSteam.