Symptoms of Hidradenitis Suppurativa (HS)

Article written by
Alison Channon

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 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. HS rarely develops after menopause in women. The timing of onset is most likely linked to the body’s changing levels of sex hormones.¹

HS is not contagious. HS symptoms are not caused by poor hygiene or sexually transmitted infections.^1,2

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.³

HS typically impacts the following areas of the body:^4,5

• 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.^2,6

Early or mild symptoms of hidradenitis suppurativa
Early symptoms of HS vary from person to person. Possible early symptoms include:

• A single painful bump in an area of the body typically impacted by HS⁴
• An individual painful bump that disappears after a few weeks, but then reappears⁴
• Tender, swollen, or red patches of skin under the arms, in the groin, around the buttocks, or under the breasts⁷

Cases of hidradenitis suppurativa are classified by stages, from mild stage I to stage III, the most severe. These early symptoms can also be classified as stage I HS. About two-thirds of people with HS will never progress past mild or stage I.⁸ However, some people’s symptoms will progress over time and become more severe.

Symptoms of progressive HS
Over time, HS symptoms may become more widespread, more painful, and more disruptive to a person’s life.

Moderate HS Symptoms
As HS progresses, it may transition from mild or stage I HS, to moderate or stage II HS. Symptoms of stage II HS include:⁶

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

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

• Multiple bumps across one area of the body⁶
• Extensive tunneling between lesions⁶
• Extensive scarring²
• Ruptured lesions with foul smelling pus⁴

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.^1,4,6,9

Hidradenitis suppurativa flares
HS follows a flare/remission cycle. 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:⁷

• 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.¹⁰

Pain with hidradenitis suppurativa
Many people with HS experience pain and discomfort because of the condition. Some people whose HS is poorly controlled experience near constant pain from inflamed lesions. People with less severe symptoms or better controlled HS may only experience pain during flares.¹¹

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.¹² 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.⁹ 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.

Resources

External Resources

• Hidradenitis suppurativa symptoms & causes – Mayo Clinic
• Hidradenitis Suppurativa – National Organization for Rare Disorders
• Hidradenitis Suppurativa: Signs and Symptoms – American Academy of Dermatology Association

Internal Resources

• Hidradenitis Suppurativa – An Overview
• Hidradenitis Suppurativa – The Path to Diagnosis
• Hidradenitis Suppurativa – Stages
• What Causes Hidradenitis Suppurativa?
• Treatments for Hidradenitis Suppurativa

FAQ

Can early diagnosis and treatment help prevent hidradenitis suppurativa symptoms from becoming more severe?
HS is a progressive condition, meaning it can grow worse without treatment. Early diagnosis and treatment of HS can help improve outcomes in many people by preventing symptoms from becoming more severe and slowing progression.¹³

At what age do hidradenitis suppurativa symptoms appear?
HS symptoms usually develops after puberty, between ages 20 and 30. HS symptoms occasionally develop in the early teen years. People rarely develop HS after age 40. Some women with HS find that symptoms diminish after menopause.^4,14

Do men and women experience different HS symptoms?
HS occurs much more frequently in women than in men. Women experience HS at a rate three times that of men. While HS is more common in women, men are more likely to develop severe HS.¹⁴ In both men and women, HS almost always develops after the start of puberty.⁷

Men and women with HS may experience slightly different HS symptoms. Women with HS tend to develop lesions on in the armpits, in the groin area, and under the breasts. Men with HS more frequently develop lesions around the anus.¹ While this presentation is more common, both men and women can develop HS symptoms on any area of the body where the condition can occur.

Women may also experience HS flares during menstruation.⁷ Some women experience a reduction in HS symptoms after menopause.⁴


References

1. Harding, M. (2016, December 2). Hidradenitis Suppurativa: HS: Causes, Tests & Treatment. Retrieved July 26, 2019, from https://patient.info/skinconditions/hidradenitis-suppurativa-leaflet.
2. Hidradenitis Suppurativa. (n.d.). Retrieved from https://www.hs-foundation.org/what-is-hs/. Accessed August 2019.
3. Sweat glands. (n.d.). Retrieved from https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/multimedia/sweat-glands/img-20007980. Accessed August 2019.
4. Hidradenitis suppurativa. (2019, May 16). Retrieved from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306. Accessed August 2019.
5. Hidradenitis Suppurativa. (n.d.). Retrieved from https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa. Accessed August 2019.
6. Lee, E. Y., Alhusayen, R., Lansang, P., Shear, N., & Yeung, J. (2017). What is hidradenitis suppurativa? Canadian Family Physician,63, 114-120.
7. Hidradenitis Suppurativa. (n.d.). Retrieved from https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/. Accessed August 2019.
8. Zouboulis, CC; Desai, N; Emtestam, L; Hunger, RE; Ioannides, D; Juhász, I; Lapins, J; Matusiak, L; Prens, EP; Revuz, J; Schneider-Burrus, S; Szepietowski, JC; van der Zee, HH; Jemec, GB (2015). “European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa.” The Journal of the European Academy of Dermatology and Venereology. DOI: 10.1111/jdv.12966
9. Mental & Emotional Health Support. (n.d.). Retrieved from https://www.hs-foundation.org/mental-emotional-health/. Accessed May 2019.
10. Hidradenitis suppurativa and diet: What's recommended? (2018, December 29). Retrieved from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/expert-answers/hidradenitis-suppurativa-diet/faq-20182593
11. Managing Pain in HS. (n.d.). Retrieved from https://www.hs-foundation.org/wound-care-nutrition/managing-pain-hs/. Accessed August 2019.
12. Thorlacus L, Cohen AD, Gisalon GH, et al (2017). “Increased suicide risk in patients with hidradenitis suppurativa.” Journal of Investigative Dermatology. Retrieved at https://www.ncbi.nlm.nih.gov/pubmed/28942360. DOI: 10.1016/j.jid.2017.09.008
13. Hidradenitis Suppurativa. (n.d.). Retrieved from https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa. Accessed August 2019.
14. Dufour, D. N., Emtestam, L., & Jemec, G. B. (2014). Hidradenitis suppurativa: A common and burdensome, yet under-recognised, inflammatory skin disease. Postgraduate Medical Journal,90(1062), 216-221. doi:10.1136/postgradmedj-2013-131994

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