If you, or someone you know, has experienced chronic recurring painful bumps or boils in and under the skin, it may be hidradenitis suppurativa or HS for short. People all over the world are living with this condition but Black people are more likely to develop HS than white people.1,2 HS affects about 296 Black people for every 100,000 versus 98 white people for every 100,000.3 It also affects 3x more women than men.1,2
About 30% of people with HS have a family member with the disease. In this article, we will go over the causes, signs, symptoms, and treatment of hidradenitis suppurativa.
What is Hidradenitis Suppurativa?
HS starts in the hair follicles of the skin. The hair follicles become blocked which eventually leads to scarring and inflammation4 and pus-filled bumps on the skin or hard bumps under the skin can progress to painful, inflamed areas (lesions).2
Picture of Moderate Hidradenitis Suppurativa in the Armpits 6
Image from Merck Manual, courtesy of Dr. Karan McKory, MD.
Signs, Symptoms, and Progression of Hidradenitis Suppurativa 7
The severity of HS varies from person to person. Some people may only have a few mild infected bumps (abscesses) while others may have tunnels under the skin (sinus tracts), and pus filled bumps that are severe. HS symptoms tend to occur in places where skin touches skin. The pus may have a strong odor or cause wet spots on your clothes. Without treatment, HS is likely to progress. Abscesses may heal slowly without treatment if they heal at all, and return causing permanent scars.
Here are some of the symptoms you may see if your HS is not treated and advances.
- Pimples or boils in places that have hair like the breast, armpit, lower abs, genitals, around the anus, buttocks, and inner thighs
- Breakouts on your skin that come and go
- Burning, itching, swelling, or excessive sweating in an area of your skin
- Tender, deep nodules
- Large, painful abscesses
- Blackhead-looking small bumps
Unfortunately, delay in diagnosis can result in significant scarring and emotional toll. If you have any of these signs and have not seen a dermatologist, you should make an appointment. A primary care physician may mistake HS for infection-related boils or acne. Dermatologists have special training that helps them recognize the signs of hidradenitis suppurativa.4,7
The progression of hidradenitis suppurativa, especially if untreated, may follow these stages:
- Area of skin feels uncomfortable
- Tender, deep nodule(s) appear
- Nodules grow and start to join together
- Large, painful infected bumps (abscesses) break open
- Black-head like spots appear
- Deeply scarred skin occurs
- Abscesses heal slowly (if at all) and return
- Scars start to form
Check out these photos of how hidradenitis suppurativa appears on Black skin:
Images from the American Academy of Dermatology Association and WebMD
Causes of Hidradenitis Suppurativa
The exact cause of HS is unknown and it usually begins after puberty.5,8,9 We do know that the condition develops and progresses after the hair follicle becomes clogged. Sweat and protein found within your skin build up and lead to painful bumps or boils.7 There has been evidence that shows a family link to getting HS. One in three people with HS have a relative with the condition.2 We also know that:
- HS is not contagious.
- HS is not a sexually transmitted infection (although you may have boils on your genitals).
- HS is not a result of poor hygiene.
References
- HS Foundation (2024) What is HS https://www.hs-foundation.org/what-is-hs Accessed August 20, 2024
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (2024) Hidradenitis Suppurativa (HS) https://www.niams.nih.gov/health-topics/hidradenitis-suppurativa-hs Accessed August 20, 2024
- Journal of American Medical Association Dermatology (2017) Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States https://pubmed.ncbi.nlm.nih.gov/28492923/ Accessed August 26, 2024
- Cleveland Clinic (2024) Hidradenitis Suppurativa (Acne Inversa) Symptoms and Treatments https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa Accessed August 19, 2024
- My HS Team (2023) What is Hidradenitis Suppurativa: Facts and Pictures https://www.myhsteam.com/resources/what-is-hidradenitis-suppurativa-hs Accessed August 23, 2024
- Merck Manual (2024) Hidradenitis Suppurativa https://www.merckmanuals.com/home/skin-disorders/acne-and-related-disorders/hidradenitis-suppurativa Accessed August 20, 2021
- American Academy of Dermatology Association (2024) Hidradenitis Suppurativa: Signs and Symptoms https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-symptoms Accessed August 19, 2024
- American Academy of Dermatology Association (2024) Hidradenitis Suppurativa(2024) https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview Accessed August 26, 2024
- WebMD (2023) Hidradenitis Suppurativa https://www.webmd.com/skin-problems-and-treatments/hidradenitis-suppurativa Accessed August 26, 2024
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