SRx Health

Painful Skin Lumps? It Might Be Hidradenitis Suppurativa

It might feel like a deep pimple, but it could be a chronic condition. Find out what you need to know.

Some skin conditions are easily recognizable, like acne. But what if you’re having symptoms that seem similar to acne but are hidden below the surface? It could be a condition called hidradenitis suppurativa, which affects as many as one million Canadians.

The first step to getting relief from any health condition is finding out what it is and learning about the problem. In that vein, let’s dive into hidradenitis suppurativa and everything you need to know.

Table of Contents

1. What Is Hidradenitis Suppurativa?

2. Symptoms of Hidradenitis Suppurativa

3. What Causes Hidradenitis Suppurativa?

4. Potential Complications of Hidradenitis Suppurativa

5. Treatments for Hidradenitis Suppurativa

6. How to Reduce Your Risk for Hidradenitis Suppurativa or Complications of Hidradenitis Suppurativa

7. What to Do if You May Have Hidradenitis Suppurativa

What Is Hidradenitis Suppurativa?

Hidradenitis suppurativa, or HS, is a chronic condition that causes hair follicles in your skin to become blocked, creating small inflamed lumps under your skin. It happens because of an overactive immune system that creates excessive inflammation in specific areas.

The lumps you develop are generally painful, feeling similar to a deep pimple. In fact, hidradenitis suppurativa is sometimes called “acne inversa” because it’s similar to acne, but it occurs within your skin rather than on the surface of your skin.

Stages of Hidradenitis Suppurativa

If you’re diagnosed with hidradenitis suppurativa, your doctor will categorize your HS based on how advanced and how severe it is. There are three stages of hidradenitis suppurativa, known as the Hurley stages:

  • Hurley stage I: One lump or a few isolated lumps without tunnels below the skin, called sinus tracts, that connect the bumps
  • Hurley stage II: Multiple lumps along with sinus tracts and some initial scarring
  • Hurley stage III: Multiple lumps with significant sinus tracts and scars so that an entire area of your body is affected

Symptoms of Hidradenitis Suppurativa

Hidradenitis suppurativa can be difficult for people to recognize because it’s not widely known and because its symptoms can look and feel much like acne. Symptoms of HS include:

  • Small pea-sized lumps under your skin that are often painful and may also be itchy
  • Lumps under your skin that primarily form in areas where your skin rubs together, like your armpits, groin, buttocks, inner thighs, breasts, and other areas
  • Indented scars under the skin where lumps once were
  • Frequent blackheads in pitted areas of skin, usually in pairs
  • Lumps under the skin that may get larger, break, and leak odorous pus
  • Tunnels under your skin that connect lumps
  • Lumps under the skin that typically appear on both sides of your body

These symptoms usually start in your 20s or 30s, but they can start at any age. They can also come and go in waves, similar to the way acne symptoms tend to flare up with breakouts every so often.

What Causes Hidradenitis Suppurativa?

Unfortunately, research hasn’t been able to find the root cause of hidradenitis suppurativa. As with many conditions, it’s likely to be a combination of several contributing factors. Genetics, hormones, and environmental or lifestyle factors all seem to play a role in the development of HS. We do know, though, that HS is not related to hygiene so it doesn’t mean you aren’t washing your skin well, and we know that it isn’t contagious.

Potential Complications of Hidradenitis Suppurativa

While hidradenitis suppurativa can have a significant impact on your day-to-day life because of the physical discomfort and the self-consciousness that comes from its appearance, the good news is that it rarely leads to dangerous complications. There are still some complications and risks that can come from HS, though.


Hidradenitis suppurativa lesions can become infected, and those infections could become serious in rare cases. If an infection arises, your doctor will likely prescribe antibiotics to get the infection under control.

Hidradenitis suppurativa Infection
Credit: Unsplash

Long-Term Scarring

You’re probably familiar with acne scars: acne lesions can damage tissue in your skin, leading to scars that usually look like indents in your skin. Hidradenitis suppurativa can create similar scars under your skin, and sometimes these scars can improve over time, but they may also be permanent.

Skin Cancer

Studies have found that people with HS have a higher risk of skin cancer. More specifically, a particular type of skin cancer called squamous cell carcinoma tends to develop in a long-standing HS lesion. Your doctor will want to monitor you more closely for skin cancer if you have HS.

Localized Swelling

Many of the areas that HS often affects, like the groin and the armpits, are also areas that have a lot of lymph nodes. Lymph nodes allow your body to drain cellular waste. When you have HS in an area with lymph nodes, the HS can block or interfere with your lymph nodes so they can’t drain waste as well. This leads to swelling in your arms, legs, or groin.

Treatments for Hidradenitis Suppurativa

If you believe you have hidradenitis suppurativa, what are the next steps? While there’s no cure for this condition, there are treatments that can manage and minimize your symptoms.


One of the primary issues your doctor will watch for if you have HS is an infection in your lesions. If an infection seems to be developing, they will prescribe antibiotics to treat it. They might prescribe topical antibiotics or oral antibiotics.


If you’re having significant symptoms, your doctor may use corticosteroids to reduce the swelling and inflammation. They will typically inject corticosteroids into your lesions, or they might prescribe oral steroids in some cases.

Oral Retinoids

Prescription retinoids are often used to treat acne, and some can help with hidradenitis suppurativa as well. These are usually only used for severe HS because some, like Accutane, can have serious risks and side effects.

Hormone Therapy

Hormones often play a role in hidradenitis suppurativa, so your doctor might prescribe certain hormonal medications to reduce your symptoms. This could include estrogen-containing birth control pills for women or a type of hormone medication called spironolactone that is often used to treat acne.


Biologics are medications that help to manage your immune response by targeting certain proteins that your immune system produces. Because HS stems from an overactive immune system, biologics can reduce that immune response and keep your symptoms to a minimum.


In some cases of persistent, severe hidradenitis suppurativa, surgery could be an option to address specific painful lumps that keep coming back. There are various types of surgeries your doctor could perform depending on your specific needs, including draining or removing specific lesions, turning HS pockets into non-painful scars, skin grafting, and using specialized lasers.

How to Reduce Your Risk for Hidradenitis Suppurativa or Complications of Hidradenitis Suppurativa

If you’re prone to HS or if you have HS and want to do what you can to keep your symptoms to a minimum, there are lifestyle choices you can make to benefit yourself in the long term.

Manage Your Weight

Research has found that people who are overweight are more likely to have hidradenitis suppurativa and to have more significant symptoms. Reaching or maintaining a healthy weight could lower your risk of HS and severe symptoms.

Avoid Smoking

People who smoke are more likely to have HS. The research shows that smoking can trigger hidradenitis suppurativa initially, but it’s not conclusive as to whether smoking makes HS worse after you have it. Still, smoking does reduce your body’s ability to heal wounds, so it’s likely that avoiding smoking will limit your HS symptoms and complications.

Hidradenitis suppurativa Smoking
Credit: Unsplash

Don’t Irritate Sensitive Areas

In areas where you have HS symptoms, the less inflammation you have, the better. Avoid anything that could inflame or irritate your skin in these areas, like using potentially irritating skin care products and shaving.

What to Do if You May Have Hidradenitis Suppurativa

SRx is your go-to resource for treating and managing your health, and that includes hidradenitis suppurativa. Our integrated healthcare system will take a holistic approach to your HS so you can get your symptoms under control and enjoy a life with less discomfort. To get started, contact your nearest SRx today.

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