Hidradenitis suppurativa (HS) often begins subtly but can dramatically affect your quality of life if left untreated. Being aware of the first symptoms is crucial — early intervention can prevent severe complications and improve overall well-being when living with this chronic skin condition.

This article explores the earliest signs of HS, common misinterpretations of its symptoms, and the reasons prompt diagnosis is so important. Recognizing HS early can make all the difference in managing this painful condition and preventing it from getting worse.

Earliest Signs and Symptoms of Hidradenitis Suppurativa

HS often begins with mild symptoms that can be easy to overlook or misinterpret. Knowing what to watch for can help you catch it early and seek medical advice.

Small, Painful Lumps

One of the first indications of HS involves small, painful lumps (also called “nodules”) that form under the skin. The lumps are often tender to the touch and may be mistaken for pimples, cysts, or boils. They range in size and tend to develop where skin touches skin, like the armpits, groin, and genital area.

Initially, these lumps are about the size of a pea and feel hard. They may be discolored and feel warm. Over time, the lumps can grow and become more painful, eventually turning into abscesses that can rupture and leak fluid.

Blackheads

Clusters of blackheads, which often appear in a characteristic pattern such as a double-headed blackhead, can be an early HS symptom. The blackheads might not be painful, but their presence in unusual areas like the armpits or groin can be a clue.

Itching and Discomfort

You might experience persistent itching or discomfort in areas like the armpits, thighs, or groin before you notice any lumps or bumps. Itching is often an early indicator of HS because it suggests underlying irritation in the skin. The discomfort may be mild at first but become more bothersome as the condition progresses.

Discharge With an Odor

Eventually, the lumps may break open and release an odorous discharge. This mixture of pus and blood indicates that the condition is becoming more severe.

The discharge’s smell is due to the infection and trapped debris within the lumps. When these lumps burst, the fluid released can have a strong odor. This symptom can cause significant embarrassment and social discomfort.

Tunnels Under the Skin

In more advanced HS stages, tunnels can form under the skin, connecting the lumps and abscesses. Known as “sinus tracts,” hidradenitis suppurativa tunnels can be painful and may become infected.

Early signs of tunnel formation include a feeling of pressure or fullness under the skin. The developing tunnels can cause significant discomfort and make the skin more prone to infections.

Early Symptoms That May Be Misinterpreted

Because HS symptoms can look like those of other conditions, they’re often misinterpreted. Here are some common ways early HS symptoms are mistaken for other issues.

Acne

Hidradenitis suppurativa is also called “acne inversa,” but it’s different from acne. Acne, or acne vulgaris, usually consists of blackheads, whiteheads, and inflamed pimples on the face, back, and chest. HS is often confused with acne because both conditions can cause pimples and cysts, but HS typically occurs as larger, more painful, deeper lumps in areas where acne is less common, such as the armpits and groin.

Ingrown Hairs

Ingrown hairs occur when a hair curls back into the skin. They typically appear as small, discolored, raised bumps that may be itchy or painful, and sometimes you can see the hair trapped beneath the skin. They’re often found in areas that have been shaved or waxed, such as the legs, armpits, and bikini line.

Many people mistake HS lumps for ingrown hairs, especially when they appear where hair removal is common. Unlike ingrown hairs, HS lumps don’t improve on their own and can lead to more serious complications. Additionally, HS — but not ingrown hairs — can produce multiple interconnected lumps or tunnels.

Boils

Boils are painful, pus-filled lumps that typically look like a single lesion. They can occur anywhere but are most common on the face, neck, armpits, shoulders, and buttocks. Boils often burst and drain spontaneously or require lancing by a health care provider. HS, on the other hand, involves multiple, recurrent lumps that don’t heal completely and can form sinus tracts.

Boils are often mistaken for HS, but they’re usually caused by bacterial infections and tend to resolve with treatment. HS is a chronic condition that requires long-term management.

Folliculitis

Folliculitis is characterized by small discolored bumps that look like pimples at the base of hair follicles, often with a small amount of pus. This condition can be caused by bacterial or fungal infections, irritation from shaving, or blocked hair follicles.

Folliculitis can look similar to HS, particularly in the early stages. However, folliculitis usually affects individual follicles, whereas HS causes larger, deeper lumps and can be more severe.

Importance of Early Diagnosis of Hidradenitis Suppurativa

If you think you might have HS, it’s important to consult with a dermatology specialist about treatment options as soon as possible. An early diagnosis is crucial for several reasons.

Preventing Symptoms From Worsening

HS is a progressive condition, meaning it tends to get worse over time if not properly managed. Early diagnosis and treatment can help slow down or even halt the progression, reducing the risk of severe complications such as abscesses, anal fistulas (tunnels), and extensive scarring.

Relieving Pain and Discomfort

Early intervention can significantly reduce the pain and discomfort of HS. Treatments can help manage inflammation, help heal lesions, and prevent new lumps.

Improving Quality of Life

HS can have a profound impact on quality of life, affecting physical, emotional, and social well-being. Early diagnosis and appropriate management can help people with HS maintain a more active and fulfilling lifestyle.

Avoiding Misdiagnosis

Since HS symptoms can be mistaken for other conditions, early diagnosis by a knowledgeable dermatologist is essential. The proper diagnosis can prevent unnecessary treatments and the frustration of not knowing the true cause of the symptoms.

Recognizing the early signs of HS and seeking a prompt diagnosis are crucial steps in managing this chronic condition. If you notice symptoms such as small, painful lumps or persistent itching, check in with your health care team. Early diagnosis can help you find relief, manage symptoms, and prevent worsening of the condition. Remember, you don’t have to face HS alone — support and resources are available to help you navigate your journey.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 43,000 members come together to ask questions, give advice, and share their stories with others who understand life with. HS

What early or missed symptoms of HS have you experienced? What steps have you taken to manage your HS? Share your experience in the comments below, or start a conversation by posting on your Activities page.