What is HS?

Hidradenitis Suppurativa (HS) is a chronic skin disease, which appears in the apocrine gland-bearing areas, such as the armpits, breasts, and groin. It can also occur in other folds of skin on the body where hair follicles and/or sweat glands exist (this does not mean you have to be growing hair in those areas for HS to appear).

Often also referred to as ‘acne inversa’, HS is better described as an autoinflammatory illness. While it is a direct result of your immune system (which is why it is referred to as an autoimmune disorder or illness), the reaction in your body is due to the immune system generating too much inflammation.

The over-activity of the immune system causes inflammation in the skin which results in a mix of redness, swelling, itching, pain, sores, and drainage. People with HS also have systemic inflammation that can cause joint pain or fatigue.

Symptoms

Hidradenitis suppurativa (HS) can go undiagnosed for years. It is important to look out for common or recurring symptoms. These could start out as small bumps but could also appear as redness, darkening, or swelling of the skin.

When symptoms first appear, they appear as painful, recurrent pimples or cysts in telltale areas. Because of its appearance and location, HS is often misdiagnosed as ingrown hairs, folliculitis, staph infection, cellulitis, or an STD. But unlike those conditions, HS cannot be cured and the lesions left behind will often refill, have difficulty healing, and leave behind scars.

Identifying HS

There is so much we don’t know about this disease. This means it can look and feel different for every person. Some common changes to look out for include the following:

• If the spot becomes larger over time

• If they last for weeks or months

• If the spot is painful to touch, or painful when you move

• If they rupture or burst and drain fluid

• If they consistently reappear in the exact same area or other areas mentioned above

Depending on the appearance of the skin changes, your healthcare provider may describe these spots as nodules, abscesses, or tunnels:

• Nodules: Firm circles of inflammation deep in the skin.

• Abscesses: Firm areas of inflamed skin that have fluid in the centre. It is common for an abscess lesion to drain fluid. The drainage is often cloudy or mixed with blood, and can also have a strong odour. This is a common indicator for HS abscesses. 

• Tunnels: Tunnels are shaped like a submarine, oval or stretched-out. Like a submarine, the inflammation is deep in the skin and sometimes comes to the surface, opening into a sore and releasing fluid. Tunnels may stay constantly active or come to the surface now and again.

When these symptoms have gone away from a spot, they can leave discolouration and scars. When HS symptoms reappear or worsen, it’s called a flare or flare-up. 

The Different Stages of HS

HS is graded into 3 stages, known as Hurley's clinical staging. The early stages of HS present themselves as a single, inflamed, boil-like nodule. These will either slowly disappear or persist to become a suppurative (draining) abscess, eventually degrading and scarring the affected area.

The later stages of the disease will see the affected areas spreading, with either single or multiple lesions with the formation of sinus tracts, or fistulas, where lesions drain from 1 or more locations. These sinus tracts can interlink and become more widespread in stage 3.