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.
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:
Less frequently, HS can also occur around the neck, waist, and behind the ears.
Early symptoms of HS vary from person to person. Scarring does not occur in the early stages. Possible early symptoms include:
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.
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.
As HS progresses, it may transition from mild or stage 1 HS, to moderate or stage 2 HS. Symptoms of stage 2 HS include:
In about 4 percent of cases, HS symptoms progress to severe or stage 3. Symptoms of stage 3 HS include:
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.
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:
Some people find that certain foods, such as dairy, sugar, or brewer’s yeast, can increase their HS symptoms.
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.
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.
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