Hidradenitis suppurativa (HS) is an inflammatory skin condition that affects at least 1 in 100 people. HS can be classified into three stages of severity using the Hurley staging system. About 68 percent of people with HS the mildest form, Hurley stage 1.

People with stage 1 HS often don’t have any symptoms, and treatments usually lead to good outcomes.

What Is Stage 1 Hidradenitis Suppurativa?

HS, also called acne inversa, begins at the hair follicle. The condition may develop when inflammation causes painful nodules, boils, or abscesses that may be red, purple, or dark colored, depending on skin tone. HS is not contagious, sexually transmitted, or caused by poor hygiene.

In 1989, the Hurley staging system was created and has become the gold standard for categorizing HS. The stages include:

• Stage 1 HS — Involves one lesion or isolated abscesses (pus-filled pockets on the skin). There’s no scarring or sinus tract formations (narrow openings developing underneath the skin).
• Stage 2 HS — Involves abscesses that go away and come back, along with sinus tracts and scarring. The lesions may be spaced apart or close together.
• Stage 3 HS — Involves multiple sinus tracts that may connect to each other. Also includes abscesses that come and go and extensive scarring.

Stage 1 HS is the mildest and most easily treated form. HS lesions appear as blackheads or pea-size bumps that are sometimes mistaken for acne, boils, ingrown hairs, or herpes. The lesions appear in areas of the body where skin rubs together or where there are certain sweat glands called apocrine sweat glands. The most common locations include the armpits, groin, buttocks, and breasts.

Stage 1 HS generally begins after puberty, and mild HS is often diagnosed between the ages 20 and 24. HS is seen in women more than twice as often as in men. In the United States, HS is more prevalent among Black people than in people from other racial or ethnic background, according to Mayo Clinic.

Between 55 percent and 70 percent of people with HS never go beyond stage 1. However, if left untreated, some people’s symptoms will progress into severe hidradenitis suppurativa.

Symptoms and Pictures of Stage 1 Hidradenitis Suppurativa

Early symptoms of stage 1 HS vary from person to person. Stage 1 HS lesions can show up as painful, discolored, pea-size lumps under the skin. They sometimes appear as blackheads, also known as double-ended pseudocomedones or double-barreled blackheads. Stage 1 lesions can last for days to months and typically don’t cause scarring.

Possible early symptoms of stage 1 HS include:

• Mild discomfort, with burning, itchy skin
• Fewer than five inflammatory nodules
• A single painful bump in an area of the body typically affected by HS
• A single painful bump that disappears after a few weeks but then reappears
• Tender, swollen, or discolored patches of skin under the arms, in the groin, around the buttocks, or under the breasts

Early diagnosis and detection are key to managing stage 1 HS in the long term. If you notice abscesses in the common areas, you should bring the bumps to the attention of your doctor immediately. In addition, take note of any changes in abscesses, such as if they grow or change color.

Treatments for Stage 1 Hidradenitis Suppurativa

There’s no cure for HS, but many treatment options can help you manage symptoms. Dermatologists recommend treatments partly based on stage. They may also consider factors such as your:

• Severity of symptoms
• Number of lesions
• General health and medical history

Stage 1 HS is the most easily treated stage. Your doctor may recommend one or more of the following therapies:

• Oral antibiotics (taken by mouth) such as doxycycline or rifampin to reduce inflammatory lesions
• Topical antibiotics (applied to skin) such as clindamycin
• Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, or other over-the-counter pain relievers to treat pain and inflammation
• Oral contraceptive pills or other hormonal therapy options to regulate hormone levels
• Corticosteroid injections to treat early painful nodules that aren’t infected and to reduce inflammation
• Laser hair removal to reduce the number of hair follicles on the skin, which may help reduce the number of lesions over time
• Topical antiseptic washes, such as 4 percent chlorhexidine or benzoyl peroxide, to keep skin clean and reduce the risk of infection

Surgery and biologic medications aren’t usually used for people with mild HS. However, biologic therapies like adalimumab (Humira) may be recommended earlier in the treatment process if conventional treatments aren’t effective, even in moderate stages of HS.

Home Remedies

Other ways to treat stage 1 HS lesions at home include:

• Applying a warm compress on the area of the skin for a few minutes
• Wearing loose-fitting undergarments and clothing to minimize friction
• Using antibacterial soap on the affected area
• Avoiding skin care products that irritate the skin
• Avoiding shaving affected areas, such as the underarms
• Minimizing heat exposure and sweating
• Keeping the area of skin dry and cool

Management of Stage 1 Hidradenitis Suppurativa

The impact of HS on a person’s quality of life can be profound. However, stage 1 HS can often be easily managed through healthy lifestyle changes.

Quitting Smoking

The link between smoking and HS is well studied. Smoking tobacco can increase inflammation throughout the body, making HS symptoms worse. Researchers have reported that most people with HS actively smoke. If you smoke, quitting may reduce your risk of flare-ups.

Changing Your Diet

Certain foods and stress can trigger HS flare-ups in some people. Mayo Clinic recommends that people with HS eliminate dairy products, consume less sugar, and avoid brewer’s yeast. Changing your diet may also be a helpful and healthy way to lose weight, if that’s a goal for you.

Keep in mind that changing your diet may not affect your HS symptoms unless you’ve identified specific food triggers that cause your symptoms to flare. Always talk to your dermatology specialist or another health care provider before changing your diet or starting an exercise program. Dietary recommendations vary based on individual responses, and that evidence linking dietary facts to HS is still limited.

Losing Weight

Like HS, obesity — defined as having a body mass index (BMI) above 30 — also contributes to inflammation. Researchers have reported a link between increasing BMI and the greater severity of HS. Weight loss or healthy weight management may reduce your risk of flare-ups or of your condition progressing to more severe HS.

Your health care provider can offer resources such as nutritional counseling and recommend other approaches to help you best manage your symptoms while living with HS.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 44,000 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Do you have stage 1 hidradenitis suppurativa? What treatments work for you? Share your thoughts in the comments below or by posting on myHSteam.