Skin Health More Skin Conditions Hidradenitis Suppurativa Guide Hidradenitis Suppurativa Guide Overview Symptoms Causes Diagnosis Treatment Coping Symptoms of Hidradenitis Suppurativa By Angela Palmer facebook Angela Palmer is a licensed esthetician specializing in acne treatment. Learn about our editorial process Angela Palmer Medically reviewed by Medically reviewed by Casey Gallagher, MD on September 18, 2019 Casey Gallagher, MD, is board-certified in dermatology and works as a practicing dermatologist and clinical professor. Learn about our Medical Review Board Casey Gallagher, MD Updated on August 21, 2020 Print Table of Contents View All Frequent Symptoms Complications When to See a Doctor Next in Hidradenitis Suppurativa Guide What Causes Abscesses in the Groin and Armpit Area? Hidradenitis suppurativa is a chronic skin condition that causes painful, inflamed lumps underneath the surface of the skin. These may initially resemble acne pimples or blackheads, but progress to larger lumps (called nodules) and abscesses which can rupture and leak purulent fluid. Hidradentis suppurativa most often develops in the armpit area, groin, inner thigh and genital area, and buttocks. An Overview of Hidradenitis Suppurativa Frequent Symptoms The most common symptoms of hidradenitis suppurativa are: Acne-like bumps in areas you wouldn't typically expect to find acne pimples (e.g. your armpits or groin)Painful lumps, called nodules, under the skin. These can be small or large (some nodules grow marble-sized or larger).Blackheads in areas you wouldn't expect them. A defining feature is these blackheads usually develop in pairs.Abscesses which may rupture and leak a pus-filled fluid that has an unpleasant smell The condition most often develops in skin folds and areas that get a lot of friction, like your armpits, groin, and genital area. Breakouts are also common on the inner thighs, buttocks, and under the breasts of females. If the condition progresses, breakouts may also appear on the nape of the neck, the waist (where the waistband of your pants rests), and the chest. This photo contains content that some people may find graphic or disturbing. See Photo Hidradenitis suppurativa on the groin. DermNet / CC BY-NC-ND Hidradenitis suppurativa can range from mild to severe. In mild cases, you may only have a handful of small bumps. Before they develop, you may notice a slight redness, itching, or burning in the area. In some cases, excessive sweating also occurs. As the condition progresses, nodules get larger and more painful. Some nodules will heal on their own, while others develop into abscesses. They can rupture and leak a pus-filled fluid that has a foul smell. Nodules and abscesses can grow and join with others, creating tunneling wounds underneath the surface of the skin called sinus tracts. Hidradenitis suppurativa is a chronic condition, meaning that symptoms most likely will reoccur over many years. While for some people the symptoms come and go, leaving periods of time where the skin is relatively clear, others have near-constant breakouts of nodules and abscesses. Double-Ended Pseudocomedones One defining symptom of hidradenitis suppurativa, especially in the later stages of the disease, is the development of double-ended pseudocomedones. Double-ended pseudocomedones look like what is a typical "blackhead" except for a key feature—the blackhead has two ends. So, you will see two blackheads "heads" with the entire lesion connected underneath the skin. If you push on one end, the detritus may come out of either end. These types of lesions do not develop with other conditions that resemble hidradenitis suppurativa, like folliculitis or simple abscess, so this symptom is a good clue that points to hidradenitis suppurativa. Complications Because of the deep-seated inflammation and open wounds this condition causes, hidradenitis suppurativa can lead to several complications. Scarring Due to widespread inflammation, hidradenitis suppurativa quite often causes scarring. Depending on the size, location, and severity of the breakouts, scars can range in severity from mild atrophic scars to deeper, more serious, scarring. It's unfortunately common for this skin condition to cause very severe scarring. Cord-like scars can develop on the skin's surface, following the line of skin damage that has occurred underneath the surface. Typically, the longer hidradenitis suppurativa is left untreated, or the more severe the case, the higher the risk of scarring. The scarring isn't just a cosmetic issue, although severe scarring can be disfiguring. Because the scar tissue runs deep and can be widespread, it may eventually restrict movement of the affected area. For example, severe scarring in the armpit area can restrict movement of the entire arm. Fistulas—abnormal holes that connect two organs—can also develop especially in the genital area or around the anus. Secondary Bacterial Infection Secondary bacterial infection can also develop, often Staphylococcus or Streptococcus. In rare cases, the infection can become systemic (infects your bloodstream rather than just the local area). Signs of a systemic infection include: FeverSweatingNausea or vomitingRapid heart rateGenerally feeling unwell If you have signs of a systemic infection you should call your doctor immediately. Squamous Cell Carcinoma Squamous cell carcinoma, a type of skin cancer, may be more likely to develop in those with hidradenitis suppurativa. This typically occurs in people who have had the condition for many years, probably due to the chronic inflammation caused by hidradenitis suppurativa. It can be harder to see skin cancer on skin that is inflamed or scarred. Talk to your doctor about the possible risk of developing squamous cell carcinoma, and the best way to be screened for your particular situation. Keep in mind, however, that this is a very rare complication of hidradenitis suppurativa. When to See a Doctor Abscesses are actually quite common, and most people will get at least one at some point in their life and they're very treatable. But it's when those abscesses recur that you and your doctor should start exploring reasons why. You should see your doctor when: You have a painful lump(s) or abscesses anywhere on your body.You have lumps or abscess that reoccur or will not heal.Lumps or abscesses are very large, severe, or widespread.The lumps are causing severe pain.Your lumps are worsening.You have signs of a systemic infection. A Word From Verywell Many people are embarrassed by the odor from draining abscesses, so they avoid going to the doctor. Please believe that your physician has seen it all before, and will not be shocked or judge you because of it. It is imperative that you see a doctor if you have an abscess, especially recurrent abscesses. How Hidradenitis Suppurativa Is Diagnosed Was this page helpful? Thanks for your feedback! Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Dufour DN, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgraduate Medical Journal. 2014;90:216-221. doi:10.1136/postgradmedj-2013-131994 Lee EY, Alhusayen R, Lansang P, Shear N, Yeung J. What is hidradenitis suppurativa? Can Fam Physician. 2017 Feb;63(2):114-120. Lacarrubba F, Musumeci ML, Nasca MR, Verzì AE, Fiorentini F, Micali G. Double-ended Pseudocomedones in Hidradenitis Suppurativa: Clinical, Dermoscopic, and Histopatho-logical Correlation. Acta Derm Venereol. 2017 Jun 9;97(6):763-764. doi:10.2340/00015555-2601 Guet-Revillet H, Coignard-Biehler H, Jais JP. Bacterial Pathogens Associated with Hidradenitis Suppurativa, France. Emerg Infect Dis. 2014 Dec;20(12):1990–1998.doi:10.3201/eid2012.140064 Lapins J, Ye W, Nyrén O, Emtestam L. Incidence of Cancer Among Patients With Hidradenitis Suppurativa. Arch Dermatol. 2001;137(6):730–734. doi:10-1001/pubs.Arch Dermatol.-ISSN-0003-987x-137-6-dst00132 Additional Reading Saunte DML, Jemec GBE. Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA. 2017 Nov 28;318(20):2019-2032. doi:10.1001/jama.2017.16691