Health Conditions A-Z Skin, Hair & Nail Conditions Signs and Symptoms of Hidradenitis Suppurativa By Courtney Southwick Courtney Southwick Courtney Southwick is a freelance writer focusing on health, nutrition, and disease. She has been blogging for the past two years at CourtneySouthwick.com. She writes blogs and articles for online publications and for healthcare professionals in private practice. She provides well-researched articles and has been published in Health, Livestrong, Healthnews, EatingWell, and Cleanplates. health's editorial guidelines Published on September 27, 2023 Medically reviewed by Susan Bard, MD Medically reviewed by Susan Bard, MD Susan Bard, MD, is a board-certified general and procedural dermatologist with the American Board of Dermatology and a Fellow of the American College of Mohs Surgery. learn more Trending Videos Close this video player Boy_Anupong / Getty Images Hidradenitis suppurativa (HS) is a chronic skin condition characterized by painful lumps under the skin. HS—also called acne inversa—is inflammatory and non-contagious. The lumps form in hair follicles in areas of your body where skin rubs against skin, like the armpits, inner thighs, groin, or under the breasts. The lumps can turn into painful abscesses that can leak and form scars. Hidradenitis suppurativa is relatively common, affecting about 1 in 100 people. However, a 2022 study found that it has taken an average of 10 years for people with HS to get proper diagnoses. Because of this, many people who live with HS experience symptoms for years or even decades before finding a diagnosis. HS symptoms tend to worsen over time, especially if it's is left untreated. Symptoms often start in one part of the body and spread to other areas over time. The stages are referred to as Hurley Stages I-III. There is no cure, and the cause of hidradenitis suppurativa is complex and not fully understood. Fortunately, many people still find relief from HS symptoms with available treatments. Early HS Symptoms The first symptom of hidradenitis suppurativa are bumps or nodules breaking out on your skin, often resembling a pimple. It is usually accompanied by pain or stinging just before the nodule breaks through the skin. HS nodules often disappear for a while and then reappear in the same spot. Medical professionals refer to the beginning stages as Hurley Stage 1, and it is characterized by one or a few nodules. Sometimes these nodules form abscesses (a swollen area where pus accumulates), which can become infected. This photo contains medical imagery. See Image Dermnet NZ Progressive HS Symptoms As HS progresses, nodules often join together and form large, painful areas on your skin. The nodules are more likely to become abscesses and fill with fluid. The abscesses can break open and leak foul-smelling fluid, including pus or blood. As symptoms progress, it is called Hurley Stage 2. At this stage, abscesses are recurring regularly and are scarring over. Tunnels, called sinus tracts, form under the skin, connecting the nodules together. Triggers for new nodules include weight gain, stress, hormonal changes, menstruation, and excessive heat or sweating. This photo contains medical imagery. See Image Dermnet NZ Severe HS Symptoms When HS becomes very advanced, multiple nodules and abscesses have formed and are running into each other. Often, the bumps can appear as two blackheads, side by side. The abscesses will heal and then reappear and worsen, repeatedly. At this stage, extensive sinus tracts have formed under the skin. The tunnels can become infected and cause permanent scars. People with advanced HS have multiple nodules, abscesses, and scars in differing stages of advancement. This stage is referred to as Hurley Stage 3, and is characterized by abscesses grouped together across an entire area of skin. With advanced HS, scarring can lead to restricted movement and pain. This photo contains medical imagery. See Image Dermnet NZ Hidradenitis Suppurativa Symptoms in Children HS has always been viewed as an adult disease, but recent studies show that up to 50% of people with HS begin to experience symptoms between the ages of 10 and 21. Little is known about HS in children, and since the condition is often misdiagnosed at first, most people are well into adulthood before they receive the correct diagnosis. Children experience the same types of symptoms that adults do, but they often have comorbidities—other conditions that accompany HS. These are often related to hormones and include early menstruation, obesity, hypothyroidism, polycystic ovary syndrome (PCOS), and early puberty. Symptoms in Men and Women HS symptoms are typically the same across sexes, but studies show that women are disproportionately affected; they’re three times more likely to have HS compared to men. When men do get HS, the symptoms are often more severe. Studies also show that the condition is more common in Black people, particularly Black or biracial women. When to Contact a Healthcare Provider If a bump forms on your skin in areas of friction, such as the armpit or groin, it’s important to reach out to a healthcare provider. The earlier that HS is diagnosed and treated, the less likely it will be to advance to painful stages. Dermatologists are doctors who treat skin conditions, and they tend to be most familiar with HS and its various treatment options. There is no cure for HS, but many types of treatments are available that can help reduce the number of flare-ups and slow the progression of the condition. Treatments focus on reducing the number of new nodules and abscesses and keeping the condition from advancing. Treatment options typically include pain management, wound care, and skin care. There are numerous medications and medical procedures that are also used to treat HS. A Quick Review Hidradenitis suppurativa is a progressive, chronic skin condition that tends to affect women more often than men. Left untreated, this condition worsens and causes pain and discomfort. Scar tissue and pain from the abscesses can make it difficult to move freely. Fortunately, many treatment options are available, and they have been found to be effective for many people. Frequently Asked Questions Does hidradenitis spread? Yes, HS tends to spread to bigger areas of skin and other areas of the body over time, especially if left untreated. It is not contagious and cannot spread to other people. Can you pop HS bumps? It is recommended to leave HS bumps alone. Popping HS bumps or nodules can irritate the skin and worsen your symptoms. Does hidradenitis suppurativa smell? HS abscesses can easily become infected and rupture. If they do leak, the fluid is usually foul-smelling. Was this page helpful? Thanks for your feedback! Tell us why! Other Submit 7 Sources Health.com uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Ballard K, Shuman VL. Hidradenitis suppurativa. In: StatPearls. StatPearls Publishing; 2023. American Academy of Dermatology Association. Hidradenitis suppurativa: Overview. Garg A, Naik HB, Kirby JS. A Practical Guide for Primary Care Providers on Timely Diagnosis and Comprehensive Care Strategies for Hidradenitis Suppurativa. Am J Med. 2023;136(1):42-53. doi:10.1016/j.amjmed.2022.09.025 American Academy of Dermatology Association. Hidradenitis Suppurativa Signs and Symptoms. Hallock KK, Mizerak MR, Dempsey A, Maczuga S, Kirby JS. Differences between children and adults with hidradenitis suppurativa. JAMA Dermatology. 2021;157(9):1095. doi:10.1001/jamadermatol.2021.2865 Shih T, Seivright JR, McKenzie SA, et al. Gender differences in hidradenitis suppurativa characteristics: A retrospective cohort analysis. International Journal of Women’s Dermatology. 2021;7(5):672-674. doi:10.1016/j.ijwd.2021.07.003 American Academy of Dermatology Association. Hidradenitis suppurativa: Self-care.