HS is often misdiagnosed or not recognised to begin with. It can take more than 7 (or longer!) to receive a formal diagnosis of Hidradenitis Suppurativa.

HS is often mistaken for a once-off boil or abscess, an ingrown hair, or other type of infection.

There are several early warning signs that if recognised in time can lead to an early diagnosis and effective treatment to stop the disease progressing.

When it first develops, HS can have symptoms that range from clusters of blackheads (little pits or tiny tunnels in your skin), mild itching and discomfort, to the appearance of red, tender, and swollen areas. These can range in size from from a pea to much larger (e.g., tennis ball).

Click on the symptoms below for further detail.

Typical locations for HS

Image source: (Accessed 2021)

Physical Symptoms

HS typically appears on certain parts of the body, including:

– In the armpits

– Around the bottom

– Under, on, and between the breasts

– Beside and on the genitals

– Around the groin

– The inner thighs

– The area between the anus and the genitals


HS is most common in areas where there is skin-on-skin contact. However, it can occur elsewhere on the body such as the back, neck, face, scalp, behind the ears.

In some people, the cycle of a bump appearing, filling, and then opening (known as a flare) can reoccur in the exact spot; in others, flares occur in the same area but not in the exact same spot.


Some people have constant flares on their skin while in others, scars may be the only sign of HS.

The cycle of the lesions appearing, draining, and healing, along with the formation of tunnels can cause the skin to contract and form scars that look like knots or are rope like in appearance. It can cause the skin to become tight and restrict movement.

HS can be a very painful condition, however, there are different ways to help relieve the pain.

During flare ups your body is fighting infection. This, combined with experiencing pain and varying degrees of mobility difficulties will contribute to a complete lack of energy. It may be difficult to motivate yourself to engage in activities, or to concentrate.

The location, and or pain from HS lesions, can make it difficult to move freely sometimes. For example, painful lesions under your arms may make it uncomfortable to raise your arms.

The Stages of HS

HS is usually classified into three stages called Hurley staging (named after the surgeon who proposed this scheme [insert ref]).

Hurley Stage I

This may be a single lesion without sinus tract (tunnel) formation.

Hurley Stage II

Single or multiple lesions, but with limited tunneling.

Hurley Stage III

Multiple lesions, with more extensive tunnels and scarring. It involves an entire area of the body

Hurley staging allows doctors to assign a severity level to HS, but it does not account for other factors such as  disease activity, the pain, or the impact on a person’s quality of life. As a result, many different measurements/tools have been developed to assess HS severity to take these other factors into account. Currently, there are > 30  severity assessment measurements/tools in use but all doctors still refer to and use the Hurley staging system.