Hidradenitis suppurativa: Signs and symptoms
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.
While HS tends to develop on certain areas of the skin, it can develop in less common locations, such as near an ear or around the belly button. A few people have developed HS on their face, neck, or back; however, this is rare.
When HS develops, it tends to begin and progress as follows:
Area of skin feels uncomfortable
Before you notice a lump in your skin, you may feel some discomfort. 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 HS is often a painful spot that looks like a deep pimple, acne cyst, or boil. This spot often appears on an armpit (as shown here) or in the groin area. Some people develop a spot on the buttocks or inner thigh.
Nodules grow and start to join together
As HS 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 lumps are called abscesses.
Large, painful abscess breaks open
When an abscess breaks open, blood and pus spill out. This foul-smelling mixture can cause wet spots on your clothes. People who have HS often feel embarrassed by the odor.
In the advanced stages, some people see small black bumps that look like blackheads. These spots often appear in twos.
Abscesses heal slowly (if at all) and return; scars form
The repetitive healing and reopening eventually cause tunnels to form beneath the skin and permanent scars.
Some people have HS wounds on their skin all the time. For others, such as this patient, scars may be the only sign of HS for a while.
Treatment can prevent HS from progressing
Without treatment, HS can continue to heal and reappear. Sometimes, it worsens.
Without treatment, HS can progress from a few acne-like breakouts (left) to deeply scarred skin (right).
Living with untreated HS 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, anxiety can develop.
Depression: Medical studies have found that people who have HS tend to develop depression more often than people who do not have HS.
Infections: A bacterial infection can develop in skin with HS.
Itch: HS in the groin, armpits, or thighs tends to be the itchiest.
Pain: The deep lumps and tunnels that develop beneath the skin can be painful. Some people need prescription-strength painkillers to cope.
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 an arm, leg, or other part of your body.
Skin cancer: Some people with HS have an increased risk of developing a type of skin cancer called squamous cell carcinoma (SCC). Men who’ve had HS for many years on their genitals or around their anus are most likely to develop SCC. This skin cancer tends to occur where you’ve had HS for years.
While men are most likely to get skin cancer, they have less risk of developing HS. Researchers still haven’t discovered why women are more likely than men to get HS. Find out what they’ve learned so far at, Hidradenitis suppurativa: Causes.
Image 1: Property of the AAD
Image 2: Getty Images
Images 3–7: Used with permission of DermNet NZ.
Image 8: Images used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2009;60:539-61.)
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