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Hidradenitis suppurativa: Signs and symptoms

If you have this skin disease, you may notice breakouts on your skin that look like pimples or boils. Your skin may clear for a while, but you notice new breakouts develop in the same area.

Unlike everyday pimples, hidradenitis suppurativa (HS) forms in areas where skin touches skin. HS is most common in these areas:

  • Underarms (one or both)

  • Groin (genitals, around the anus, and surrounding area)

  • Buttocks

  • Upper thighs

  • Women’s breasts (underneath and sometimes on the breasts)

Although rare, a few studies have found HS near an ear or around the bellybutton. There have also been a few cases of HS appearing on the face, neck, or back.

Women tend to get breakouts on their genitals and upper thighs. Men are more likely to have HS on their genitals and around the anus.

Some people develop breakouts in the exact same spot each time. For others the breakouts appear in the same area, but never seem to be in the exact same spot.

In its earliest stage, hidradenitis suppurativa often looks like boils or pimples (left), but with time thick scars can form (right).

Hidradenitis suppurativa often looks like boils or pimples

Early signs and symptoms

When people first get hidradenitis suppurativa (HS), they often see:

  • One (or several) breakouts that look like pimples or boils

  • Breakouts may stay on the skin; sometimes, they clear and reappear

Later signs and symptoms

Without treatment, HS can worsen. If this disease progresses, the person may develop:

  • Painful, deep breakouts that heal and reappear

  • Breakouts that rupture and leak a foul-smelling fluid

  • Scars that form as breakouts repeatedly heal and reappear

  • Scars that become thicker with time

  • Skin that begins to look spongy as tunnel-like tracts form deep in the skin

  • Serious infections

  • Skin cancer (rare)

Signs and symptoms can change

The signs and symptoms of HS can change quickly. One week, a person may have a foul-smelling fluid leaking from breakouts. The next week, the breakouts have cleared and scars are the only sign of HS.

Some people always have breakouts on their skin.

Skin cancer risk

HS develops on skin that tends to get little or no direct sunlight. Yet, a few people have developed squamous cell carcinoma, a common type of skin cancer, where they had HS breakouts and scarring for years. Most cases developed in men who had long-standing HS on their genitals or around their anus.

Treatment helps prevent long-standing HS.

Quality of life affected

Without treatment, HS can continue its cycle of breakouts and healing. As the breakouts clear, scars form. Continual healing and scarring can cause hollow passages called fistulas to develop inside the body. Fistulas can be painful and require surgery to repair.

People who have a foul-smelling liquid draining from the breakouts can feel embarrassed. They may feel too embarrassed to see a doctor. Dermatologists understand this. You should not feel embarrassed to see a dermatologist about this problem.

Images used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol 2009;60:539-61.)

Aitken JF, Elwood M, Baade PD, et al. “Clinical whole-body skin examination reduces the incidence of thick melanomas.” Int J Cancer 2010 Jan 15;126(2):450-8.

Alikhan A, Lynch PJ, et al. "Hidradenitis suppurativa: A comprehensive review." J Am Acad Dermatol 2009;60(4):539-61.

Canoui-Poitrine F, Revuz JE, Wolkenstein P, et al. ”Clinical characteristics of a series of 302 French patients with hidradenitis suppurativa, with an analysis of factors associated with disease severity J Am Acad Dermatol 2009;61(1):51-7.

Habif T, Campbell J, Chapman M, et al. In: Dermatology DDxDeck. 2006. Mosby Elsevier. Card #35: Hidradenitis suppurativa.

Hinds, G. “Hidradenitis suppurativa: An update.” Focus session presented at the 2012 American Academy of Dermatology Summer Academy Meeting: Boston. Aug 2012.

Jemec GBE, Heidenheim M, Nielsen NH. “The prevalence of hidradenitis suppurativa and its potential precursor lesions.” J Am Acad Dermatol 1996;35(2):191-4.

Lavogiez C, Delaporte E, Darras-Vercambre S, et al. “Clinicopathological study of 13 cases of squamous cell carcinoma complicating hidradenitis suppurativa.” Dermatology. 2010;220(2):147-53

McMichael A, Sanchez DG, Kelly P. “Hidradenitis Suppurativa.” In: Bolognia JL, Jorizzo JL, Rapini RP, et al. editors. Dermatology 2nd ed. Spain, Mosby Elsevier; 2008. p. 528-9.

Sabat R, Chanwangpong A, Schneider-Burrus S, et al. “Increased Prevalence of Metabolic Syndrome in Patients with Acne Inversa.” 2012. PLoS ONE 7(2):e31810.

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