Hidradenitis suppurativa (HS) symptoms are different for everyone. Symptoms may remain consistent, worsen and subside in a pattern of flares and remissions, or grow progressively more severe. In severe cases, HS symptoms can significantly impact quality of life, affect work and school, or even be debilitating. Treatment can help manage many HS symptoms, but some cases of HS can be difficult to treat.

HS symptoms almost always begin after the onset of puberty, often between the ages of 20 and 30. The timing of onset is most likely linked to the body’s changing levels of sex hormones. Women experience HS at a rate three times that of men, but men are more likely to develop severe HS. HS rarely develops after menopause in women.

HS is not contagious. HS symptoms are not caused by poor hygiene or sexually transmitted infections.

Skin Areas Affected in Hidradenitis Suppurativa

HS usually develops in areas of the body where apocrine sweat glands are present. Most of the body is covered by eccrine sweat glands, but areas with a high concentration of hair follicles are covered in apocrine sweat glands. Apocrine glands release sweat into the hair follicle, while eccrine glands release sweat directly onto the skin.

HS typically impacts the following areas of the body:

• Armpits
• Groin
• Between the buttocks
• Inner thighs
• Underside of women’s breasts

Less frequently, HS can also occur around the neck, waist, and behind the ears.

Early or Mild Symptoms of Hidradenitis Suppurativa

Early symptoms of HS vary from person to person. Scarring does not occur in the early stages. Possible early symptoms include:

• A single painful bump in an area of the body typically impacted by HS
• An individual painful bump that disappears after a few weeks, but then reappears
• Tender, swollen, or red patches of skin under the arms, in the groin, around the buttocks, or under the breasts

Cases of hidradenitis suppurativa are classified by Hurley stages, from mild stage 1 to stage 3 — the most severe. These early symptoms can also be classified as stage 1 HS. About two-thirds of people with HS will never progress past the mild symptoms of stage 1. However, some people’s symptoms will progress over time and become more severe.

Symptoms of Progressive Hidradenitis Suppurativa

HS is a progressive condition, meaning it can grow worse without treatment. Over time, HS symptoms may become more widespread, more painful, and more disruptive to a person’s life. Lesions will seem to go away and then return. Early diagnosis and treatment of HS can help improve outcomes in many people by preventing symptoms from becoming more severe and slowing progression.

Moderate HS Symptoms

As HS progresses, it may transition from mild or stage 1 HS, to moderate or stage 2 HS. Symptoms of stage 2 HS include:

• Recurring painful lesions
• Scarring
• Formation of narrow openings underneath the skin connecting lesions (called sinus tracts, tunnels, or tunneling)

Severe HS Symptoms

In about 4 percent of cases, HS symptoms progress to severe or stage 3. Symptoms of stage 3 HS include:

• Multiple bumps across one area of the body
• Extensive tunneling between lesions
• Extensive scarring
• Ruptured lesions with foul smelling pus

Other symptoms, like infection, severe pain, limited movement due to scarring, or depression and anxiety, may also be present among people with more advanced cases of HS.

Hidradenitis Suppurativa Flares

HS follows a cycle of flares and remission. This means people with HS can experience a period of acute symptoms followed by a period of inactive disease. The possibility of a flare can create stress and worry for some people with HS even during periods of remission.

In some people, HS symptoms reliably flare and become worse during specific circumstances known as triggers. While everyone experiences HS differently, some common flare triggers include:

• Menstruation in women
• Weight gain
• Physical or emotional stress
• Hormonal changes
• Excessive heat
• Sweating

Some people find that certain foods, such as dairy, sugar, or brewer’s yeast, can increase their HS symptoms.

Pain With Hidradenitis Suppurativa

Many people with HS experience pain and discomfort because of the location of the lesions. Some people with poorly controlled HS experience near constant pain from inflamed lesions. People with less severe symptoms or better controlled HS may only experience pain during flares.

Mental Health Impact of Hidradenitis Suppurativa

Hidradenitis suppurativa can have a significant impact on a person’s quality of life. In addition to pain from bumps, tunneling, or scars, people with HS may also worry about symptoms growing worse, feel self-conscious about the smell of ruptured lesions, or fear that people will misunderstand their condition.

All of these concerns can lead to feelings of depression or anxiety. Some research has found that people with HS have a higher suicide risk than the general population. It is just as important to seek help for mental health issues as it is to seek help for HS skin symptoms.

Seeking help from a mental health provider can help people with HS who are experiencing symptoms of depression or anxiety associated with their condition. Connecting with others with HS on myHSteam or through in-person support groups can also help alleviate feelings of isolation. Some people may benefit from antidepressant medications.

Condition Guide

• Hidradenitis Suppurativa (HS) — An Overview
• Hidradenitis Suppurativa (HS) Stages
• Hidradenitis Suppurativa (HS) — The Path to Diagnosis
• Treatments for Hidradenitis Suppurativa (HS)
• What Causes Hidradenitis Suppurativa (HS)?

References

1. Hidradenitis Suppurativa: HS: Causes, Tests & Treatment — Patient
2. What is HS? — Hidradenitis Suppurativa Foundation
3. Hidradenitis suppurativa symptoms & causes – Mayo Clinic
4. Hidradenitis Suppurativa — Cleveland Clinic
5. What is hidradenitis suppurativa? — Canadian Family Physician
6. Hidradenitis Suppurativa – National Organization for Rare Disorders
7. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. — The Journal of the European Academy of Dermatology and Venereology
8. Mental & Emotional Health Support — Hidradenitis Suppurativa Foundation
9. Hidradenitis suppurativa and diet: What's recommended? — Mayo Clinic
10. Increased suicide risk in patients with hidradenitis suppurativa — Journal of Investigative Dermatology
11. Hidradenitis suppurativa: A common and burdensome, yet under-recognised, inflammatory skin disease — Postgraduate Medical Journal

Alison has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Learn more about him here. Review provided by VeriMed Healthcare Network.