Symptoms of HS: Location, Progression & Management

Yeah, that deep, tender lump under your skin... again. You press on it ouch and you know it's not a pimple. Not an ingrown hair. It's deeper. Pulsing. Maybe it's started leaking. And now it's back in the same spot. Or worse, spreading.

This isn't just "bad acne." It could be hidradenitis suppurativa (HS) a chronic skin condition that starts with painful lumps but can progress into a lifelong struggle if not recognized early.

Let's talk about what HS really feels like, where it shows up, how it changes over time and what you can actually do about it. No fluff. Just real info, straight up.

Recognizing HS Symptoms

You know that feeling when something's just not right with your body, but you can't quite put your finger on it? That's often how HS starts. These aren't your typical zits that pop up and disappear. We're talking about something deeper, more persistent, and honestly, way more frustrating.

What Does HS Actually Look Like?

Picture this: You're getting ready in the morning, and you feel that familiar twinge a deep, painful nodule that feels like a marble buried beneath your skin. These bumps aren't superficial like regular pimples. They're nestled deep in the dermis and subcutaneous tissue, which is why they hurt so much.

HS lesions look like red, swollen bumps that can easily be mistaken for boils or abscesses. But here's the kicker they don't heal quickly. While a regular pimple might clear up in a few days, HS lesions stick around for weeks or even months. And just when you think they're gone, they come back in the exact same spot. It's like they're holding a grudge against that particular patch of skin.

Before these lumps even appear, you might feel tenderness, burning, itching, or throbbing in the area. It's your body's way of sending up a flare warning you that something's brewing beneath the surface.

As dermatology experts note, "Persistent deep lumps that keep coming back are a red flag. HS is often mistaken for recurrent boils, but it's a distinct inflammatory disease," according to research from the Mayo Clinic and the American Academy of Dermatology.

HS Versus Acne: Why They're Different

Here's where things get confusing. Many people mistake early HS for acne or razor bumps. I mean, they both involve bumps on the skin, right? But there are some key differences that are worth understanding.

Feature	HS Lesions	Acne / Ingrown Hairs
Depth	Deep under skin (dermis/subcutis)	Surface or shallow
Pain Level	Often severe, constant	Mild to moderate, temporary
Recurrence	Same spot, chronic	Random, occasional
Drainage	Pus with odor, bloody fluid	Minimal, no odor
Healing	Slow, scarring common	Faster, minimal scarring

If your "pimples" aren't going away and keep coming back worse, it's time to think beyond regular acne treatment.

Where HS Typically Develops

HS has its favorite hangout spots, and they're all places where skin rubs against skin. Think about areas with friction, sweat, and blocked hair follicles. These are the trouble zones where HS loves to set up camp.

Common HS Locations

The armpits are probably the most frequent site, especially for women. It makes sense when you think about it constant movement, sweat, deodorant, and clothing friction create the perfect storm for HS to develop.

Your groin and inner thighs are also popular spots. These areas often develop symmetrical lesions, which means if you get one on your left thigh, you'll probably get a matching one on the right. And because these areas move so much, every step can feel like a reminder that something's wrong.

For those with larger busts, the area under the breasts becomes a common problem zone. The weight, movement, and trapped moisture create ideal conditions for HS to thrive.

Your buttocks and the area around your anus can also be affected, sometimes including what's called a pilonidal sinus. And don't forget about those inner thighs and waistband areas places where clothing creates constant friction.

As one real patient shared with the HS Foundation, "I thought it was just chafing at first then it got worse under my arms and thighs. By the time I saw a dermatologist, I had tunnels. I wish I knew HS was treatable earlier."

Less Common Spots

While the above areas are the usual suspects, HS can also appear in less expected places. You might find lesions on the back of your neck, near your ears, around your belly button, or even in your genital area.

These locations might catch you off guard because they're not where you'd expect to have skin issues. But remember, HS is unpredictable, and it can pop up almost anywhere your skin folds or rubs together.

How HS Progresses Over Time

Here's something important to understand: HS isn't static. It evolves, and the earlier you recognize what's happening, the better your chances of managing it effectively.

The Three Stages of HS

Medical professionals use something called the Hurley Staging System to categorize how HS progresses. Think of it like describing the intensity of a storm from isolated thunderstorms to widespread hurricanes.

Stage	What Happens	Symptoms
Stage I	Isolated abscesses, no scarring or sinus tracts	Single painful lumps, may rupture and heal
Stage II	Recurrent abscesses, beginning scarring and sinus tracts	Multiple lumps, some connect under skin, limited movement
Stage III	Extensive abscesses, widespread sinus tracts and scarring	Chronic drainage, constant pain, severe impact on daily life

Not everyone progresses to Stage III but without treatment, the risk increases significantly. This is why early intervention is so crucial.

Understanding Sinus Tracts

Let's talk about something that sounds medical but is actually quite important to understand: sinus tracts. These are tunnels that form under your skin, connecting multiple nodules. Imagine underground passages connecting different rooms in a house that's essentially what these look like beneath your skin.

They form over time due to repeated inflammation and rupture of lesions. These tunnels drain pus or blood and often have a foul smell. They heal slowly and are prone to reopening, making them a hallmark of moderate to severe HS.

When you visualize how HS develops over time, it looks something like this:

1. Early stage: One tender nodule that looks like a deep pimple
2. Mid stage: Nodules multiply, join together, and form abscesses
3. Advanced stage: Abscesses rupture, creating sinus tracts, and scar tissue builds up
4. Chronic stage: Recurrent flares, limited mobility, and significant emotional impact

Understanding Flare-Ups and Triggers

Have you ever noticed that your symptoms seem to worsen at certain times? That's not a coincidence HS flares often follow patterns, and understanding your triggers can help you take control.

What Causes HS Flare-Ups?

Hormonal shifts play a huge role, especially for women who experience premenstrual flares. Your body's chemistry changes throughout your cycle, and for those with HS, these fluctuations can trigger breakouts.

Friction and sweating are also major culprits. Tight clothes, intense exercise, or hot weather can all contribute to flare-ups. Think about how uncomfortable it feels when you're already dealing with painful lumps add sweat and friction to the mix, and it's a recipe for increased discomfort.

Stress, whether emotional or physical, can also trigger HS flares. When you're stressed, your body releases hormones that can increase inflammation throughout your system.

Smoking is strongly linked to HS severity. Research shows a direct correlation between smoking, BMI, and HS severity. According to the NHS and Mayo Clinic, "We see a direct correlation between smoking, BMI, and HS severity. Quitting smoking and weight management are part of treatment not just lifestyle choices."

Obesity increases friction and inflammation, making it another significant factor in HS flare-ups.

Complications of Untreated HS

When HS is left untreated, it can lead to serious physical and emotional consequences. Many people don't realize how much this condition can impact their overall health and quality of life.

Physical Complications

Scarring and restricted movement become common, especially in areas like the armpits and thighs where mobility is crucial for daily activities. Imagine trying to lift your arms or walk normally when the skin in those areas is constantly inflamed and scarred.

Lymphedema swelling in arms, legs, or genitals due to blocked lymph flow can develop. This creates a cycle where inflammation leads to more swelling, which in turn increases discomfort.

Secondary bacterial infections often occur in open wounds, adding another layer of complications to an already challenging situation.

In rare cases, fistulas abnormal connections to the bowel or bladder can develop. And while it's uncommon, there is an increased risk of squamous cell carcinoma (SCC), particularly in men with long-term perianal HS. The American Academy of Dermatology and Cleveland Clinic confirm that "Long-standing HS increases the risk of SCC, particularly in men with perianal disease."

Emotional Impact

The emotional toll of HS is often underestimated. Anxiety and depression are common due to chronic pain, odor concerns, and the location of lesions. You might find yourself avoiding social situations, feeling self-conscious about how you smell, or worrying about being seen.

"It's not just the pain it's the shame. I stopped going to the gym. Then I stopped seeing friends," shared one HS patient anonymously.

If you're experiencing these feelings, please know that speaking to your doctor about mental health support is important. You're not alone in this struggle, and there are resources available to help you cope with both the physical and emotional aspects of HS.

When to Seek Medical Help

Many people wait 7+ years for a correct diagnosis. That's way too long to suffer in silence. Recognizing the signs early and getting proper medical attention can make a world of difference.

Signs You Should See a Dermatologist

If you're experiencing painful lumps in typical HS areas like armpits, groin, or under the breasts, it's time to make an appointment. The same goes for recurring breakouts in the same spot your body is trying to tell you something.

Drainage with a noticeable odor, scarring, or the formation of tunnels beneath your skin are all red flags that require professional attention. And if your symptoms are interfering with daily movement or your self-esteem, don't hesitate to seek help.

Remember: Early diagnosis leads to better outcomes. HS is not your fault. It's not caused by poor hygiene, and it's definitely not a sexually transmitted disease.

How HS Is Diagnosed

There's no specific blood or skin test for HS diagnosis is clinical, meaning your doctor will examine the location of lesions, the pattern of recurrence, and look for nodules, abscesses, or tunnels.

They might take a swab to rule out infection, but it's important to understand that bacteria aren't the cause of HS they're just opportunistic visitors in an already inflamed environment.

The Hurley staging system or Sartorius score helps doctors assess the severity of your condition and determine the most appropriate treatment approach.

Managing HS Symptoms

While there's currently no cure for HS, there are many effective treatments available and they work best when started early. The key is finding what works for your specific situation.

Lifestyle Changes That Help

Quitting smoking is one of the most impactful steps you can take. I know it's easier said than done, but research consistently shows its positive effect on HS symptoms. Your dermatologist can help connect you with smoking cessation resources.

If you're overweight, losing weight can reduce friction and inflammation in problem areas. Even a modest weight loss can make a significant difference in your comfort level.

Wearing loose, breathable clothing made from natural fibers can help reduce irritation. Avoid synthetic materials that trap moisture and create more friction against your skin.

Using antiseptic washes, like 4% chlorhexidine, can help keep the affected areas clean without over-drying your skin. The NHS recommends, "Hold a warm flannel on a lump for 1015 mins, 23x/day. It won't cure it, but it can bring relief."

Avoid shaving affected areas when possible, as this can further irritate already sensitive skin. And remember that warm compresses can help drain abscesses gently but always be gentle with your skin.

Medical Treatment Options

Treatment for HS varies depending on the severity of your condition. What works for someone with mild Stage I HS might not be appropriate for someone with advanced Stage III disease.

Treatment	Use Case	How It Helps
Topical antibiotics (clindamycin)	Early-stage, mild HS	Reduces surface bacteria and inflammation
Oral antibiotics (doxycycline, rifampicin + clindamycin)	Moderate HS, long-term use	Controls inflammation, not just infection
Hormonal therapy (oral contraceptives, spironolactone)	Women with menstrual flares	Balances hormones linked to flare-ups
Biologics (adalimumab, infliximab)	Severe HS	Targets immune system (TNF-alpha blockers)
Retinoids (acitretin)	Selected cases	Regulates skin cell growth
Surgery	Draining abscesses, removing tracts	Gold standard for severe or persistent cases

Biologics can be life-changing for those with severe HS, but they do suppress the immune system. It's important to weigh the risks and benefits carefully with your dermatologist.

Natural Remedies: What Really Works?

While there are no proven home cures for HS, some people find relief with certain natural approaches. Turmeric, known for its anti-inflammatory properties, is sometimes helpful. Tea tree oil can work topically when properly diluted, though it may cause irritation for some.

Some evidence suggests that low-glycemic or anti-inflammatory diets might help reduce flare-ups, though more research is needed in this area.

The key is to never replace proven medical treatments with unproven remedies. Always consult your doctor before making any significant changes to your treatment plan.

Moving Forward with Hope

Hidradenitis suppurativa symptoms like painful lumps under the skin, recurring abscesses, and slow-healing sores are more than just skin deep. They affect your body, your movement, and your mind.

But here's the truth: you're not alone, and this isn't your fault. HS isn't caused by poor hygiene or anything you did wrong. It's a chronic inflammatory condition that can be managed especially when caught early.

From lifestyle changes to advanced medical treatments, there are real options to reduce flares, prevent scarring, and improve your quality of life.

If you're experiencing these symptoms, please talk to a dermatologist. Early action can change everything.

Your next step? Consider downloading an HS symptom tracker to help you identify patterns and triggers, or start looking for a specialist near you. You deserve relief and answers.

Remember, managing HS is a journey, and finding the right approach takes time. Be patient with yourself, celebrate small victories, and don't hesitate to reach out for support when you need it. You've got this.

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.