Visual Guide to Hidradenitis Suppurativa Stages and Symptoms
Skin ConditionsHidradenitis Suppurativa
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What Does Hidradenitis Suppurativa (HS) Look Like?

What Does Hidradenitis Suppurativa (HS) Look Like?
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Published on January 13, 2025
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Hidradenitis suppurativa (HS) — a skin condition involving lesions or abscesses, typically in areas where skin touches skin — can be difficult to identify, especially early on when it’s mild. You may think it’s just acne, or irritation from shaving, and is nothing to worry about.

But as the condition progresses, HS can be disruptive and painful. It’s important to get an accurate diagnosis from a dermatologist as soon as possible so that you can treat your HS and prevent it from getting worse.

Unfortunately, many people with HS don’t get an accurate diagnosis until years after they first develop symptoms — sometimes because they put off seeing a doctor, not realizing how important it is to start treatment right away. And since there isn’t any definitive test for HS, it needs to be identified on the basis of its appearance and your pattern of symptoms.

Here’s a guide to identifying HS in its three different stages — with photos showing what it may look like.

Stages of Hidradenitis Suppurativa: Mild, Moderate, Severe

Hidradenitis suppurativa can be assessed using what’s known as the Hurley staging system. This system assigns three stages to HS according to the severity of symptoms.

  • Stage 1 (Mild) You have one or more lesions or abscesses, but not scarring or tunnels (scar tissue connecting lesions) under the skin.
  • Stage 2 (Moderate) You have one or more abscesses that persist or recur, and have caused scarring and tunnels under the skin.
  • Stage 3 (Severe) You have recurring abscesses with scarring and tunnels covering or nearly covering an area.

Here are examples of each of the three HS stages, along with an example of HS on Black skin.

Mild HS

Mild HS symptoms single bumps on the skin
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In stage 1, or mild HS, you may have reddish bumps or nodules that may be mistaken for pimples or acne.

 As in all stages of HS, these symptoms tend to affect an area where skin touches skin, such as your armpits, groin, buttocks, or under the breasts.
Even early on, there will be signs that these aren't pimples — such as a tender, deep nodule or bump. This may be the first sign of HS.

You should see a dermatologist and get treatment at the first signs of HS. “At this stage it is very important to follow up regularly and add treatments as needed to avoid scarring,” says Faranak Kamangar, MD, a dermatologist at the Palo Alto Medical Foundation in California. If you have lesions that are tender or painful, gently cleaning the area and wearing loose-fitting clothing can help, Dr. Kamangar says.

Moderate HS

Moderate HS symptoms lumps grow and start to fill with fluid abscess
Lea Rae/Shutterstock
In stage 2, or moderate HS, you may notice that your nodules have grown and started to join together. As your lesions grow together, they can fill with fluid and become painful lumps known as abscesses. An abscess may break open and leak blood or pus. As abscesses repeatedly heal and break open again, you may develop scarring and tunnels that form beneath your skin (known as sinus tracts).

“At the first sign of scarring or tunnel formation, the HS is updated to stage 2,” says Vivian Shi, MD, the director of the Hidradenitis Suppurativa Specialty Clinic at University of Washington Medicine in Seattle and an executive board member of the Hidradenitis Suppurativa Foundation.

Some people with stage 2 HS always have lesions or abscesses, while others may see their lesions heal for periods of time and have scars that remain.

 At this stage, your doctor may prescribe a biologic to your treatments, Dr. Shi says, such as adalimumab (Humira),

 secukinumab (Cosentyx),

 or bimekizumab-bkzx (Bimzelx).

Severe HS

Severe HS symptoms tunnels form interconnected tracts, scars
Ruchard Ustine MD/Science Source
In stage 3, or severe HS, you’ll have lesions and scarring — including multiple tunnels under your skin — widely covering the affected area.

 At this stage, “A combination of biologic and oral medications are needed to control the disease,” says Shi. “Surgery is often needed to remove scarring and tunnels.”
People with severe HS are likely to have permanent scars, which may be large and uncomfortable or painful — especially if their HS went untreated for a long time.

HS on Black Skin

HS on Black skin
Alamy
Black people are more than twice as likely as white people to develop HS.

 HS is not known to affect Black people any differently from white people, as evidenced by its presentation in one clinical study. But Black participants tended to have more severe HS than white participants — suggesting that the disease may have gone unrecognized for a longer period of time, possibly because lesions are less visible in early stages.

HS lesions may not have the same appearance on darker skin as on lighter skin tones. While they may be reddish or pink on lighter skin tones, on darker skin, they may be purplish or darker in color.

No matter your race or ethnicity, “It’s important to treat HS early and avoid its progression to later stages, which can be debilitating, with a major decrease in our patients’ quality of life,” says Kamangar.

The Takeaway

  • Early stage HS may look similar to acne or pimples, while later stages will have more obvious changes, such as larger abscesses and scarring.
  • Black people are more likely to develop HS, and to have more severe disease, than white people.
  • Regardless of skin tone or the severity of symptoms, early treatment of HS is important, because it can prevent the condition from progressing to more advanced stages.
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Susan Bard, MD

Medical Reviewer
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Susan Bard, MD, is a clinical instructor in the department of dermatology at Weill Cornell Medicine and an adjunct clinical instructor in the department of dermatology at Mount Sinai in New York City. Her professional interests include Mohs micrographic surgery, cosmetic and laser procedures, and immunodermatology.

She is a procedural dermatologist with the American Board of Dermatology and a fellow of the American College of Mohs Surgery.

Dr. Bard has written numerous book chapters and articles for many prominent peer-reviewed journals, and authored the textbook The Laser Treatment of Vascular Lesions.

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A freelance health writer and editor based in Wisconsin, Quinn Phillips has a degree in government from Harvard University. He writes on a variety of topics, but is especially interested in the intersection of health and public policy. Phillips has written for various publications and websites, such as Diabetes Self-Management, Practical Diabetology, and Gluten-Free Living, among others.

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Resources
  1. Ludmann P. Hidradenitis Suppurativa: Overview. American Academy of Dermatology. May 3, 2022.
  2. Hidradenitis Suppurativa. Mayo Clinic. June 21, 2024.
  3. Vanlaerhoven AMJD et al. Hurley III Hidradenitis Suppurativa Has an Aggressive Disease Course. Dermatology. 2018.
  4. Ludmann P. Hidradenitis Suppurativa: Signs and Symptoms. American Academy of Dermatology. May 3, 2022.
  5. Highlights of Prescribing Information: Humira. U.S. Food and Drug Administration. August 2018.
  6. Highlights of Prescribing Information: Cosentyx. U.S. Food and Drug Administration. May 2021.
  7. Highlights of Prescribing Information: Bimzelx. U.S. Food and Drug Administration. November 2024.
  8. Ballard K et al. Hidradenitis Suppurativa. National Center for Biotechnology Information. May 6, 2024.
  9. Wipperman J et al. Hidradenitis Suppurativa: Rapid Evidence Review. American Family Physician. November 1, 2019.
  10. Byrd AS et al. Hidradenitis Suppurativa in Black and White Patients — a Clinical Study. European Review for Medical and Pharmacological Sciences. April 27, 2023.
  11. Hidradenitis Suppurativa. Mayo Clinic. June 21, 2024.