60-second summary
If you only remember five things, remember these:
- The pattern matters more than any single lesion: the same places, coming back over months or years.
- Common signs are painful lumps, abscesses, drainage, tunnels under the skin and scarring.
- Armpits, groin, buttocks, inner thighs and the area under the breasts are most often affected.
- Pain, leakage and odour frequently affect daily life more than the visible skin does.
- Symptoms alone do not confirm HS — a clinician makes the diagnosis.
Describing when, where and how often symptoms occur gives a clinician far more to work with than a single photo of one bad flare.
Symptoms overlap with boils, folliculitis and other conditions, so the same description can fit more than one diagnosis.
Note the affected areas, how long lesions last and what they stop you doing, and take that to your appointment.
This summary is written and updated together with the full text. The evidence, limitations and sources stay unchanged in the article below.
Continue to the detailed explanationQuick orientation
Hidradenitis suppurativa symptoms involve more than a list of individual skin changes. What matters is the combination of:
- type of lesion,
- body site,
- recurrence or chronic course,
- burden from pain, drainage, restricted movement or embarrassment.
The symptom pattern matters
Hidradenitis suppurativa is not defined by a single symptom. What matters is the combination of typical lesions, typical body sites and recurrence.
Symptoms that are frequently reported
Deep painful nodules
They often sit deeper than a superficial pimple and can cause pressure, throbbing or strong tenderness on touch.
Abscesses and weeping lesions
Inflamed lesions can open and release dischargeDischarge / Exudate: Fluid coming from an Acne Inversa lesion or tunnel. Can be clear (serous), bloody (sanguineous), pus-like (purulent), or a mix.. This can significantly affect wound care, clothing, concerns about odour and everyday life. An HS abscessAbscess: An inflamed cavity or swelling containing pus or fluid. In hidradenitis suppurativa, abscesses can form as part of the inflammatory disease process and do not automatically mean that a bacterial infection is present. Secondary bacterial infection can occur and may require separate medical assessment. In Acne Inversa, abscesses occur mainly in the armpits, groin, and other skin folds. is an inflammatory lesion and does not automatically mean the area is bacterially infected. Secondary infectionSecondary Bacterial Infection: A bacterial infection that develops in skin already affected or damaged by another condition. Open or draining HS lesions can sometimes become secondarily infected. This is a possible complication of HS, not the underlying cause of the disease. can occur, particularly when the skin barrier is disrupted, but this requires separate clinical assessment. HS odor and drainage covers why draining lesions can smell and what that odor does and doesn’t indicate.
Sinus tracts or tunnels
With longer-standing disease, channels can form under the skin that connect inflamed areas or repeatedly weep.
Scars and hardened areas
Recurrent inflammation can leave behind scar tissue, cord-like indurations or restricted movement.
Pain and loss of function
Pain is commonly reported as a central symptom. In the armpits, lifting the arm can become difficult; in the groin or buttocks, walking and sitting can be a burden. The intensity and impact of symptoms vary considerably between individuals.
Describing symptoms over time
A single finding on one particular day can shorten the story. For the medical assessment, it is therefore helpful to describe symptoms over time:
| Observation | Question for your own notes |
|---|---|
| NoduleNodule: A firm, palpable lump deep in tissue. Nodules can be painful and may progress to abscesses. They are among the typical early signs of Acne Inversa. or abscess | Is the area deep and painful? |
| Drainage | Does the area open up or weep repeatedly? |
| Scar or induration | Does a change remain after a flareFlare: A period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.? |
| Daily life | Does sitting, walking, lifting the arm, sleep or clothing become harder? |
This makes it visible whether you are dealing with a single skin inflammation or a recurrent pattern that should be discussed specifically.
Where symptoms call for particular attention
Typical regions are the armpits, groin, genital and perineal area, buttocks and skin folds under the breasts. Other sites are possible. However, location alone does not determine the diagnosis.
What you should describe when reporting symptoms
A good description includes:
- where the lesions appear,
- how often they recur,
- whether they are painful, open up or weep,
- whether scars or tracts remain,
- how much daily life and sleep are affected.
This helps turn individual complaints into a clinically relevant pattern.
What is often underestimated
Drainage, concerns about odour, questions about dressings, embarrassment and pain are not side issues. They can determine whether someone is able to work, sleep, move or even show intimate complaints at all. So don’t just say how big a spot is, but also what it changes in daily life.
What symptoms do not automatically mean
Not every nodule in the groin and not every wound on the buttocks is HS. Depending on the site and course, other causes can come into play. That is no reason to play down complaints. It is the reason to have them assessed professionally.
When you should take action
Recurrent painful lesions in typical regions belong in a dermatological consultation. In case of fever, rapid worsening, strongly increasing redness or very severe pain, prompt medical help is needed.
Terms explained in this article
Quick definitions of the key medical terms. Select any term for its full glossary entry.
- Nodule
- A firm, palpable lump deep in tissue. Nodules can be painful and may progress to abscesses. They are among the typical early signs of Acne Inversa.
- Abscess
- An inflamed cavity or swelling containing pus or fluid. In hidradenitis suppurativa, abscesses can form as part of the inflammatory disease process and do not automatically mean that a bacterial infection is present. Secondary bacterial infection can occur and may require separate medical assessment. In Acne Inversa, abscesses occur mainly in the armpits, groin, and other skin folds.
- Discharge / Exudate
- Fluid coming from an Acne Inversa lesion or tunnel. Can be clear (serous), bloody (sanguineous), pus-like (purulent), or a mix.
- Secondary Bacterial Infection
- A bacterial infection that develops in skin already affected or damaged by another condition. Open or draining HS lesions can sometimes become secondarily infected. This is a possible complication of HS, not the underlying cause of the disease.
- Sinus Tract
- A tunnel-like channel under the skin that forms between abscesses or nodules. Sinus tracts indicate more advanced disease and can chronically drain fluid. They are associated with Hurley Stages II and III.
- Flare
- A period of acute worsening in a chronic condition. In Acne Inversa, a flare may be triggered by stress, hormonal changes, friction, or other factors and can manifest as new nodules, abscesses, or increased pain.
FAQ
Which symptom proves hidradenitis suppurativa?
No single symptom proves HS. The medical assessment combines typical lesions, typical body sites and a recurrent or chronic course.
Is pain part of hidradenitis suppurativa symptoms?
Yes. Pain can be very distressing with inflammatory nodules, abscesses, open lesions or scarred areas and should be described specifically during the appointment.
Are sinus tracts always visible early on?
No. Sinus tracts and scars can develop over time and may not yet be clearly visible when symptoms first appear.
References
- S2k Guideline for the Treatment of Hidradenitis Suppurativa / Acne Inversa AWMF, 2024
- Hidradenitis Suppurativa U.S. Food and Drug Administration, 2024
- North American clinical management guidelines for hidradenitis suppurativa, Part I Journal of the American Academy of Dermatology, 2019
- Hidradenitis suppurativa Nature Reviews Disease Primers, 2020
