7 Symptoms Never to Ignore with Hidradenitis Suppurativa

Medically Reviewed By William C. Lloyd III, MD, FACS
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  • Hidradenitis suppurativa (HS), also called acne inversa, is a chronic inflammatory skin disease that tends to develop after puberty. The most common HS symptoms are pimples or small lumps that develop under the skin, often in high-friction areas like the groin, underarm, buttocks, or breasts. These lumps often grow deeper into the skin and leak a bad-smelling pus or liquid before healing over. That’s the extent of the condition for some people, but others also develop additional symptoms that shouldn’t be ignored.

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    Deep Connected Tracts Between Lesions or Scars
    closeup of skin and scar tract

    In mild cases of hidradenitis suppurativa, you may only have lumps and lesions that are the hallmark of this disease. But in a severe case, you may start to develop tunnels or tracts that connect the lumps. Sometimes, these tunnels take a very long time to heal over or don’t heal over at all, and they may leak fluid or pus. If you’re developing these tunnels, it could be a sign that your condition is worsening. You may also be more prone to infections developing in the affected areas.

  • 2
    Lesions That Don’t Heal
    closeup of raw wound on skin

    Usually, those lumps and lesions will last for a while, then heal over. Sometimes scar tissue will form afterward, too. But lesions that don’t heal after a few weeks–or reappear shortly after treatment–should warrant a call to your doctor. It could be a sign of infection, or it may be a sign your current treatment plan needs adjusting.

  • 3
    Unusual Changes to Lumps or Scars
    closeup view of arm with scar or cut

    Keep an eye on those lesions and scars. If you notice some changes to them, you might want to get them checked out, since people with hidradenitis suppurativa tend to experience higher rates of certain kinds of skin cancers. Squamous cell cancers often present as thick, scaly patches or sores that don’t fully heal. Treatment is usually very successful when the cancers are caught in early stages, but they can become more challenging to treat in later stages.

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    Feeling tired and washed out? Research suggests fatigue is a very common sign that a hidradenitis suppurativa flare is developing. If you know an HS flare-up is coming, you can prepare better for it, and perhaps avoid doing certain activities that tend to trigger an exacerbation of symptoms.

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    People with hidradenitis suppurativa often experience depression at a greater rate than the general population. It’s often linked to people’s fear that others will look at them and be disgusted by their skin condition. Sometimes people with HS will even shy away from being around others, which can create feelings of loneliness or isolation. These feelings can make them feel sad and hopeless. If you notice you’re experiencing these feelings, let your doctor know right away so you can discuss how to take care of your mental health. You may want to talk to a counselor or therapist, join an HS support group, or try a medication to help you regulate your emotions. If you have any thoughts of harming yourself or others, call the National Suicide Prevention Lifeline 24/7 at 1-800-273-8255. Help is always out there.

  • 6
    Extreme Pain
    Senior man massaging knee pain

    Pain is not uncommon with hidradenitis suppurativa. Those deep cysts can hurt a great deal, although the amount and severity of pain can vary from person to person. However, if your normal level of pain shoots through the roof, or the pain changes in some way, don’t brush it off. It could be a sign that something is wrong. Pain can also lead to additional stress that can compound any feelings of depression you may be experiencing. Contact your doctor to find relief and avoid any serious complications.

  • 7
    More Lesions
    view of back of shirtless Caucasian man covered in lesions or boils

    If you find you’re developing more painful lumps or boils, or they’re popping up in more places on your body, talk to your doctor. Changes in your condition often warrant some changes to the way you treat or manage your hidradenitis suppurativa. There are effective treatments available for HS, and being honest with your doctor is the first step to getting control of your condition.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 May 1
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THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Dufour DN, et al. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgraduate Medical Journal 2014;90:216-221. https://pmj.bmj.com/content/90/1062/216
  2. Hidradenitis suppurativa. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306
Hidradenitis Suppurativa. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/hidradenitis-suppurativa/
  1. Hidradenitis suppurativa: When does it appear? Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/in-depth/hidradenitis-suppurativa-appear/art-20168979
  2. Jovanovic M. Hidradenitis Suppurativa. Medscape. https://emedicine.medscape.com/article/1073117-overview
  3. Ring HC, et al. Prodromal symptoms in hidradenitis suppurativa. Clinical and Experimental Dermatology. 2017. 42; 3: 261-265. https://onlinelibrary.wiley.com/doi/abs/10.1111/ced.13025
  4. Squamous Cell Carcinoma: Warning Signs. Skin Cancer Foundation. https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/scc-warning-signs-and-images/