Hidradenitis suppurativa: Signs and symptoms
Where does hidradenitis suppurativa develop on the body?
You usually get hidradenitis suppurativa (HS) on parts of the body where skin touches skin and has thick, course hair, such as the armpits or groin.
As the disease progresses, some people may have deep, painful lumps under their breasts. This skin condition can also develop in less common locations like near an ear or around the belly button. Some people develop boil-like lumps on their face, neck, or back.
The following picture shows where this skin condition is likely to develop.
What are the signs and symptoms of hidradenitis suppurativa?
If you have this skin disease, you may notice breakouts on your skin that look like pimples or boils. Often, these breakouts clear for a while. Later, you may see new breakouts develop in the same area. Sometimes, the breakouts develop in exactly the same spot.
The following pictures show how hidradenitis suppurativa develops and can worsen without treatment.
Area of skin feels uncomfortable
Before you notice a lump in your skin, an area of skin may feel tender or painful. The area where the lump will appear may swell. Some people say their skin burns, itches, or sweats excessively.
Tender, deep nodule(s) appears
The first sign of hidradenitis suppurativa is often a painful lump that looks like a deep pimple, acne cyst, or boil. This lump often appears on an armpit (as shown here) or in the groin area. It can also appear on the buttocks or inner thigh.
Nodules grow and start to join together
As this skin condition progresses, you see more lumps that may look like acne or boils. These lumps can grow and join together. As the lumps grow together, they fill up with fluid and become painful. These painful, fluid-filled lumps are called abscesses.
Large, painful abscess breaks open
When an abscess breaks open, blood and pus spill out. This mixture can cause wet spots on your clothes, and people often say they feel embarrassed by the odor.
Blackhead-like spots
In the advanced stages, some people see small black bumps that look like blackheads. You may see several blackhead-like bumps.
Abscesses heal slowly (if at all) and return; scars form
The repetitive healing and reopening may eventually cause scars and tunnels to form under the skin. Some people have painful lumps or abscesses on their skin all the time. For others, scars may be the only sign of hidradenitis suppurativa that they see when their skin is not flaring.
Treatment can prevent hidradenitis suppurativa from progressing
Without treatment, the painful lumps can continue to heal and reappear. Sometimes, the disease worsens. When this happens, hidradenitis suppurativa can progress from a few acne-like breakouts (left) to deeply scarred skin (right).
What does it feel like to live with untreated hidradenitis suppurativa?
This skin disease can affect your life in different ways. Some people develop one or more of the following:
Anxiety: If you don’t know what’s happening to your skin and why you keep getting these lumps, you may feel anxious.
Changes to your quality of life: Pain, odor, or draining lesions can strain personal and intimate relationships, affect decisions about what clothes to wear, or cause you to feel isolated and alone. You may no longer participate in activities that you once enjoyed. Some people feel less motivated or less able to perform at work or school.
Depression: Medical studies have found that people who have hidradenitis suppurativa tend to develop depression more often than people who do not have this skin condition.
Infections: A bacterial infection can develop in skin with deep lumps or tunnels that are draining.
Itch: The groin, armpits, and thighs tend to be itchiest.
Pain: The deep lumps and tunnels that develop beneath the skin can be painful. Dermatologists help patients manage this pain.
Scars that restrict movement: As the body produces more and more scar tissue, the scars can thicken. Some scars become so thick that they limit how far you can move. You may have trouble reaching for objects. Walking may become difficult.
Sleep loss: Pain and itch can affect your ability to fall asleep and stay asleep, making the next day feel harder. Continual sleep loss can lead to feeling fatigued every day. Some patients say that they were unaware of how fatigue was affecting their life until treatment improved their symptoms.
Can hidradenitis suppurativa cause joint pain?
If you have hidradenitis suppurativa, you may develop joint pain. Arthritis is often the cause of this joint pain. In studies, researchers have found that hidradenitis suppurativa increases your risk of developing some types of arthritis.
Joint pain and morning stiffness are common with arthritis.
Researchers continue to study this connection between hidradenitis suppurativa and joint pain. We know that both cause inflammation. This fact may shed more light on what causes hidradenitis suppurativa.
To find out what researchers have learned so far about causes, go to, Hidradenitis suppurativa: Causes.
Images
Image 1: Property of the AAD
Image 2: Getty Images
Images 3 - 6: Used with permission of DermNet NZ
Image 7: Image used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2020;83:144-4).
Image 8: Images used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2009;60:539-61).
References
Daveluy S, Okoye GA. “Quality of life and the patient journey in hidradenitis suppurativa.” J Am Acad Dermatol. 2024 Dec;91(6S):S8-11.
Garg A, Neuren E, et al. “Evaluating patients’ unmet needs in hidradenitis suppurativa: Results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project.” J Am Acad Dermatol 2020;82:366-76.
Lee EY, Alhusayen R, et al. “What is hidradenitis suppurativa?” Can Fam Physician. 2017;Feb;63(2):114-120.
McGrath BM, Atherton D, et al. “Exploring the impact of fatigue and sleep disturbance in hidradenitis suppurativa: Perspectives from patients and healthcare professionals.” Acta Derm Venereol. 2026 Apr 16;106:0179.
Naik HB, Yeung H, et al. “Joint American Academy of Dermatology-Hidradenitis Suppurativa Foundation guidelines of care for the management of hidradenitis suppurativa.” J Am Acad Dermatol. Published online Oct 20, 2026.
Narla S, Price KN, et al. “Proceeding report of the Fourth Symposium on Hidradenitis Suppurativa Advances 2019.” J Am Acad Dermatol. 2021;Jan;84(1):120-9.
Scheinfeld N. “Hidradenitis suppurativa: A practical review of possible medical treatments based on over 350 hidradenitis patients.” Dermatol Online J. 2013 Apr 15;19(4):1.
Schneeweiss MC, Kim SC, et al. “Risk of inflammatory arthritis after a new diagnosis of hidradenitis suppurativa.” JAMA Dermatol. 2020 Mar 1;156(3):342-5.
Written by:
Paula Ludmann, MS
Reviewed by:
Jennifer Adams, MD, DTM&H, FAAD
Steven Daveluy, MD, FAAD
Kelley Redbord, MD, FAAD
Abigail Waldman, MD, FAAD
Last updated: 10/20/26