Symptoms of Hidradenitis Suppurativa

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Hidradenitis suppurativa is a chronic skin condition that causes painful, inflamed lumps underneath the surface of the skin. At first, they may look like acne pimples or blackheads, but then they progress to larger lumps (called nodules) and abscesses that can rupture and leak pus. This condition most often develops in the:

  • Armpit
  • Groin
  • Buttocks
  • Inner thigh
  • Genital area

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 that 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.

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.

Hidradenitis suppurativa of groin
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 abscesses, 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.

Bacterial Infection

The wounds can also become infected with bacteria, 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:

  • Fever
  • Sweating
  • Nausea or vomiting
  • Rapid heart rate
  • Generally 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.

Other Cancers

Research published in 2020 identified an elevated risk of multiple types of cancer in people with hidradenitis suppurativa, including:

Remember that this is an increase in risk and doesn't mean that you will develop any of these cancers.

When to See a Doctor

Abscesses are actually quite common, and most people will get at least one at some point in their life. 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:

  • Painful lump(s) or abscesses anywhere on your body
  • Lumps or abscesses that reoccur or will not heal
  • Very large, severe, or widespread lumps
  • Lumps that cause severe pain
  • Lumps that are getting worse
  • 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.

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  3. Lacarrubba F, Musumeci ML, Nasca MR, Verzì AE, Fiorentini F, Micali G. Double-ended pseudocomedones in hidradenitis suppurativa: Clinical, dermoscopic, and histopathological correlation. Acta Derm Venereol. 2017 Jun 9;97(6):763-764. doi:10.2340/00015555-2601

  4. 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

  5. Fabbrocini G, Ruocco E, De Vita V, Monfrecola G. Squamous cell carcinoma arising in long-standing hidradenitis suppurativa: An overlooked facet of the immunocompromised districtClin Dermatol. 2017;35(2):225-227. doi:10.1016/j.clindermatol.2016.10.019

  6. Jung JM, Lee KH, Kim YJ, et al. Assessment of overall and specific cancer risks in patients with hidradenitis suppurativaJAMA Dermatol. 2020;156(8):844-853. doi:10.1001/jamadermatol.2020.1422

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