The most common places for hidradenitis suppurativa (HS) to manifest are the underarms, groin, upper thighs, buttocks, and — on women — the breasts. However, there are other, less common places where skin lesions can appear. Atypical sites for HS include the jaw, the legs, and the face.

More than 1,000 myHSteam members have reported lesions on the face as a symptom of HS. “I get them on my face, but they don't come to a head,” a member said. Another reported, “I get them on my face as well. I will not get them drained however, it is a pride thing.”

What Does HS on the Face Look Like?

Members have described a variety of ways HS manifested on their faces:

• “I had one just by the side on the bridge of my nose. It made the whole side of my face swell for days. Looked like I’d been punched.”
• “My son has HS. He is always in pain. He's had some new spots coming on his face and the back of his head.”
• “Had one on my face this week. This makes this condition even more unpleasant when it’s in places where you can see it.”
• “Mine came in the face too. That started last year when I went to sleep and woke up with my nose swollen, then my lips and my jaws. I get them inside my mouth also.”

While HS on the face is less common than in other places on the skin, the symptoms are similar. Here are some common symptoms:

• Small pitted blackheads, which often appear in pairs.
• Pea-sized lumps on the skin, which are usually painful to the touch and form in areas with hair follicles and many sweat glands. They also form in areas where skin rubs together, although this is not usually seen on the face.
• Tunnels that connect the lumps, also called tracts. They heal slowly, or not at all, and often leak pus.
• Scarring when lumps heal.
• Acne vulgaris, or severe acne. One study found that 15 percent of people with HS had acne vulgaris as well. As with HS, acne vulgaris can leave skin scarred and cause lesions similar to HS lesions. (Acne and HS look similar, but are not the same. Each requires different treatments. Scars from tunneling are common in HS, but not with acne.)

How Does HS on the Face Affect People?

Because it is so visible, myHSteam members reported more distress with HS on the face than other places. Describing facial lesions, one member said, “I get paranoid I'm going to end up with a huge one again that requires surgery to deal with and it terrifies me.” Another talked about facial pain. “I also have had a huge flare-up within the past two weeks. … Has included my face, my chest, and the original site inside my right breast. … I’m tired of being in pain or sick all the time.”

What Causes HS on the Face?

In most cases of HS, lesions only occur in parts of the body containing apocrine glands — the underarms, buttocks, breasts, and near the genitals. It is considered atypical for HS to occur in locations without apocrine glands, such as the face and eyelids. It is possible but uncommon to develop HS on the face; facial symptoms may also be caused by a separate skin condition.

Several other skin conditions can cause symptoms similar to HS, including acne vulgaris and folliculitis. To determine which condition is causing your facial symptoms, you need to consult a dermatologist with experience in diagnosing hidradenitis suppurativa.

How Is HS on the Face Treated?

Many treatment options for HS on the face are identical to treatments for HS lesions on other parts of the body. In some cases, different medications may be recommended due to the specific location of lesions.

Antibiotics

Antibiotics can be used to treat infection of tracts or lumps, or used in a lower dosage to treat inflammation. One myHSteam member said, “My GP has put me on Doxycycline for three months. I’ve not had a flare-up since.” Antibiotics are usually given as oral medication, but an antibiotic cream made from Erythromycin can also be prescribed. “I have two topical creams to use that do help a lot,” another member said.

Anti-Acne Washes

Anti-acne washes and facial scrubs cannot take away the cause of hidradenitis suppurativa, but they can be used to reduce facial bacteria and clogging in hair follicles.

Immunologics

Immunologics and immunosuppressant drugs, such as corticosteroids, are used to reduce inflammation in HS. However, doctors may prescribe only lower-potency corticosteroids for the face to avoid side effects such as skin atrophy. Humira (Adalimumab), which neutralizes tumor necrosis factor alpha, is given as an injection. Humira works by blocking cytokines present in immune system dysfunctions. “I am now trying Humira. It seems to be helping with my boils on the face, but I still have flare-ups in other places,” a myHSteam member said.

Hormonal Birth Control

For some women, birth control pills help reduce HS symptoms. They work by suppressing the hormones that make breakouts less likely. “When I was taking the pill, my HS symptoms almost went away,” one member shared.

Finasteride

Finasteride, an androgen-reducing medication, has proven effective in certain cases. It also works on HS by altering hormones.

Retinoids

Retinoids such as Soriatane (Acitretin) are given in some cases. While they primarily work to treat acne, they can be used for HS as well. Retinoids are vitamin-A-derived medications. Since they are known to be extremely toxic to a developing fetus, women on the drug must use two different forms of birth control when taking them. (Small amounts of the drug have been found in the semen of men, but it’s not known whether it is enough to affect an embryo at conception.) Some types of retinoids, like Isotretinoin, do not appear to have much of an effect on HS.

Surgical Treatments

Surgical treatments are typically only used when the above treatments have not been successful. Surgical procedures that can be done on the face include:

• Laser Surgery — A laser is used to clear breakouts.This treatment may work because it destroys the hair follicles.
• Uncovering Tunnels — Also known as “unroofing,” this procedure removes tissue to uncover the tracts beneath.
• Surgical Removal — This is usually considered a last-resort option. In tissue-sparing surgery, excision of tissue is combined with electrosurgical peeling to save as much tissue as possible. Excision without peeling removes all affected skin, but skin grafts are often needed to cover the removed areas.

Tips From MyHSteam Members

Members of myHSteam have reported a variety of treatment options for facial HS:

• “I personally use a tea tree stick on them and they dry out quite well, but it is difficult not to be tempted to pick at them before they fully heal.”
• “Hot compresses help also.”
• “I don't wear any makeup at all.”
• “Try getting a cold compress, like a gel-filled pouch that you keep in the fridge.”
• “I just keep draining them and use tea tree oil and lavender oil.”
• “I recently purchased a dermaplane blade and I am using it daily, gently, in scarred and sore, itchy areas on my face.”
• “I use Veet for sensitive skin with coconut oil.”

Have you experienced HS symptoms on the face? Do you have questions or tips to share? To start or join a conversation, comment below or on myHSteam.