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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.

Infographic of where hidradenitis suppurativa can develop on the skin.
Hidradenitis suppurativa (HS) begins where skin touches skin. If you have a tender, deep lump in any of these areas of your body, see a board-certified dermatologist for a diagnosis. Click the image to download a copy of this infographic.

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.

A woman with sore skin in her armpit.

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.

Hidradenitis suppurativa nodule on an armpit.

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.

Hidradenitis suppurativa can look like a boil or pimple.

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.

Hidradenitis suppurativa can leak fluid.

Blackhead-like spots

In the advanced stages, some people see small black bumps that look like blackheads. These spots often appear in twos.

Blackheads due to hidradenitis suppurativa.

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.

Scars on thighs due to hidradenitis suppurativa.

Treatment can prevent HS from progressing

Without treatment, HS can continue to heal and reappear. Sometimes, it worsens.

Hidradenitis suppurativa

Without treatment, HS can progress from a few acne-like breakouts (left) to deeply scarred skin (right).

Pictures of early and advanced Hidradenitis suppurativa.

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.)

Alikhan A, Sayed C, et al. “North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations Part I: Diagnosis, evaluation, and the use of complementary and procedural management.” J Am Acad Dermatol 2019;81:76-90.

Bowers J. “Tailor-made care.” Dermatol World. 2020;30(7);114-9.

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.

Narla S, Price KN, et al. “Proceeding report of the fourth Symposium on Hidradenitis Suppurativa Advances (SHSA) 2019.” J Am Acad Dermatol. 2020;S0190-9622(20)30989-0. doi: 10.1016/j.jaad.2020.05.114. Online ahead of print.

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.