Guides

Symptoms of Acne Inversa

Common symptoms and why clinical assessment matters.

60-second summary

If you only remember five things, remember these:

The pattern matters more than any single lesion: the same sites, recurring over months or years.
Common signs are painful nodules, abscesses, drainage, tunnels under the skin, and scarring.
Most often affected: armpits, groin, buttocks, inner thighs, and the area under the breasts.
Pain, drainage, and odor often burden daily life more than how the skin looks.
Symptoms alone don't confirm a diagnosis — that's for a clinician to assess.

When, where, and how often symptoms occur tells a clinician far more than a single photo from a particularly bad day.

Symptoms overlap with boils, folliculitis, and other conditions. The same description can fit more than one diagnosis.

Note affected sites, how long lesions last, and what they stopped you from doing — and bring that to your appointment.

Track symptoms and patterns

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 explanation

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HS symptoms can look different from person to person and change over time, which is part of why the condition is often missed early on. This page brings together the lesion types, body locations, and less visible symptoms — pain, itch, fatigue — that make up the overall picture.

It is written to help you describe what you're noticing more precisely, not to diagnose it. A recurring pattern at the same site is the detail worth raising in an appointment, more than any single lesion on its own.

What Is Acne Inversa?

Start with the basics if you're new to the condition.

Diagnosis Guide

How these symptoms are assessed, and how to prepare for that conversation.

What HS can look like

A visual guide across different skin tones and presentations.

Recognising early symptoms

What the earliest, mildest signs can look like.

Could This Be HS? Appointment Pack

Organize a recurring pattern of symptoms into a one-page summary for a clinician. No diagnosis generated.

The main lesion types

HS lesions progress through recognisable forms: tender nodules under the skin, which can develop into abscesses; drainage or discharge, sometimes with odor, when a lesion opens; tunnels (sinus tracts) that form when lesions recur and connect under the skin; and scarring in areas that have been affected repeatedly.

Not every person experiences every stage, and the order can vary. A single abscess does not prove HS — recurrence at the same site is the pattern clinicians look for.

Painful nodules — deep, tender lumps that can persist for days to weeks
Abscesses — larger, fluid-filled swellings that may open and drain
Drainage and odor — discharge from open or draining lesions
Tunnels (sinus tracts) — channels under the skin connecting recurring lesions
Scarring — rope-like or thickened scarring in repeatedly affected areas

Symptoms beyond the skin

Pain is frequently the most disruptive symptom and is not always proportional to how a lesion looks — it deserves to be described concretely in an appointment, not minimised. Itch is also common and, in surveys, reported by a wide range of patients before and during flares.

Fatigue is part of the disease burden for many people, driven by chronic inflammation, pain, disrupted sleep, and the physical toll of managing flares — though fatigue has many possible causes and shouldn't automatically be assumed to be 'just HS'.

Body locations

Where symptoms typically appear

HS follows skin folds where apocrine sweat glands are concentrated and skin rubs against skin. Each location article below covers what tends to be specific to that area.

Armpits

One of the most common sites; movement and friction from clothing and daily activity often make symptoms there especially noticeable.

Read more: Acne Inversa under the arms

Groin

A frequent site where skin folds and moisture combine; can affect mobility and clothing choices.

Read more: Acne Inversa in the groin

Buttocks

Can affect sitting for long periods and is sometimes confused with a pilonidal sinus.

Read more: Acne Inversa on the buttocks

Under the breasts

The skin fold under and between the breasts is a common site, especially with tight or underwired clothing.

Read more: Acne Inversa under the breast

Genital and intimate area

A sensitive but real location for HS; shame often delays raising it, even though it's medically relevant information.

Read more: Acne Inversa in the genital area

What to note before an appointment

Which body areas have been affected, even if not all at once
How long individual lesions typically last
Whether the same site has been affected more than once
How pain, sleep, movement, or work have been affected
Whether lesions have drained, scarred, or felt like tunnels under the skin

When not to wait for a routine appointment

Fever, spreading redness, or feeling significantly unwell
Pain severe enough to limit sitting, walking, or arm movement
A wound that is spreading, bleeding heavily, or not safely manageable at home

Internal links

Acne Inversa under the arms

What this location tends to look like and why friction plays a role.

Acne Inversa in the groin

Symptoms specific to this fold and how they can affect movement.

Acne Inversa on the buttocks

How to tell it apart from a pilonidal sinus and other look-alikes.

Acne Inversa under the breast

Symptoms in the inframammary fold and clothing considerations.

Acne Inversa in the genital area

A direct, non-judgemental look at symptoms in this location.

Recognising early symptoms

What HS can look like before it's obvious.

Key sources for this pillar page

Last editorially reviewed: 22 May 2026

S2k guideline on the therapy 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