Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic skin condition characterized by painful lumps that form under the skin. These lumps typically appear in areas where skin rubs against skin, such as the armpits, groin, inner thighs, and under the breasts. Without treatment, these lumps may develop into pus-filled abscesses that can leak, form scars, and worsen over time.

HS affects about 1 in 100 people, though it often takes an average of 10 years for individuals to receive an accurate diagnosis. Many people with HS experience symptoms for years or even decades before getting proper care.

While HS can worsen if left untreated, early intervention can help reduce flare-ups and prevent the condition from becoming more severe.


Early HS Symptoms

first signs
The earliest symptom of hidradenitis suppurativa is the appearance of bumps or nodules that look similar to pimples. These lumps are often painful or tender before they break through the skin. Many people experience a cycle of these nodules disappearing and reappearing in the same spots.

At this stage, the condition is classified as Hurley Stage 1, and typically involves only one or a few nodules. In some cases, these nodules can form abscesses, which are swollen pockets of pus under the skin that may become infected.


Progressive HS Symptoms

worsening of symptoms
As HS progresses, the number of nodules increases, and the lumps may become larger and more painful. Abscesses become more frequent, and these can break open, leaking pus or blood.

At Hurley Stage 2, abscesses start to recur regularly and form scarring. Tunnels, called sinus tracts, may develop under the skin, connecting the lumps together.

Common triggers for new nodules include weight gain, stress, hormonal changes, menstruation, and excessive heat or sweating.


Severe HS Symptoms

advanced stages
In the most advanced stages of HS, multiple nodules and abscesses merge, creating large, painful areas. The abscesses often heal and then reappear, repeatedly worsening over time. Extensive sinus tracts form under the skin, and the tunnels may become infected, causing permanent scarring.

At Hurley Stage 3, abscesses form across larger areas of skin. Scarring may restrict movement and cause significant pain, making daily activities more difficult.


Hidradenitis Suppurativa Symptoms In Children

symptoms in younger individuals
Hidradenitis suppurativa was once thought to be an adult condition, but recent studies show that up to 50% of individuals experience symptoms between the ages of 10 and 21. Since HS is often misdiagnosed, many children go undiagnosed until adulthood.

Children with HS experience the same types of bumps and abscesses as adults, but they are also more likely to have related conditions, such as early menstruation, obesity, polycystic ovary syndrome (PCOS), or hypothyroidism.


Symptoms In Men And Women

gender differences
While HS symptoms are generally similar across genders, women are disproportionately affected by the condition, being three times more likely to develop it than men. Men who do develop HS tend to experience more severe symptoms.

Studies also show that HS is more common in Black individuals, particularly Black or biracial women.


When To Contact A Healthcare Provider

early diagnosis is crucial
If you notice lumps forming in areas where skin rubs against skin, such as the armpit or groin, it’s important to contact a healthcare provider. Early diagnosis and treatment can prevent HS from advancing to more painful stages. Dermatologists, who specialize in skin conditions, are typically the best resource for diagnosing and treating HS.

Although there is no cure for HS, treatments can help manage symptoms and reduce flare-ups. Treatment focuses on reducing pain, preventing new nodules and abscesses, and preventing the condition from worsening.


A Quick Review

Hidradenitis suppurativa is a progressive, chronic skin condition that often affects women more than men. Left untreated, it can worsen, leading to painful lumps, abscesses, and scarring that can restrict movement. Fortunately, there are various treatments available that help manage symptoms and improve quality of life.