Painful bumps. “Ingrown hairs” that don’t go away. Sores that come back in the same spot. Drainage, scarring, or tenderness. Many people experience these symptoms and are told they’re temporary skin issues — things like boils, pimples, or irritation from shaving or sweat. And for some people, that is all it is.
But for many others, these ongoing or recurring symptoms are signs of a less well-known inflammatory condition called Hidradenitis Suppurativa (HS).
HS is often misdiagnosed or overlooked, especially early on. Because it can start small with a single bump, a sore spot, something that looks minor, people may spend years treating symptoms without realizing there’s an underlying condition causing them.
This doesn’t mean you have HS — but if these symptoms keep returning, lasting longer than expected, or becoming more painful over time, it may be worth asking your doctor about it.
If you’ve been dealing with this, it’s important to know: this is not your fault. HS is not caused by poor hygiene, something you did wrong, or a lack of care for your body.
If you’re reading this because something doesn’t feel quite right — because the bumps last too long, hurt too much, drain, scar, or keep coming back — this information may apply to you, even if you’ve never heard of HS before.
Let’s walk through common HS symptoms, along with questions to ask your doctor and ways to find relief while you wait for care. Recognizing patterns is often the first step toward answers. Most importantly, know that you are not alone.
Understanding Symptoms of HS
HS symptoms can look and feel different from person to person — and even change over time for the same person. Paying attention to what shows up, how long it lasts, and how it feels can help you and your doctor make better decisions together.
Below, each symptom includes questions you can bring to your appointment and steps you can take between visits to track what’s happening.
Ingrown Hair Cysts (Follicular Cysts)
These bumps often look like ingrown hairs or clogged pores but behave differently, lasting longer, growing larger, and coming back in the same spot.
Questions to Ask Your Doctor
- Could this be HS rather than a typical ingrown hair or pimple?
- How long should a follicular cyst last before it’s considered abnormal?
- Are there treatments that can help prevent these from turning into abscesses?
- Should I avoid shaving or certain hair removal methods in this area?
What You Can Do
- Note where the bump appears and whether it shows up in the same spot repeatedly.
- Track how long it lasts (days, weeks, months).
- Take photos (for personal reference) to document changes in size or redness.
What May Help Bring Relief Right Now
- Give the area a break. Pausing shaving, waxing, or hair removal can help calm irritated skin.
- Choose comfort over pressure. Loose, breathable clothing may help reduce rubbing and sensitivity.
- Use warmth if it feels soothing. A warm (not hot) compress can sometimes ease tenderness.
- Resist the urge to pick or squeeze. It’s understandable but leaving bumps alone may help prevent worsening inflammation.
Painful Bumps or Abscesses
Abscesses are deeper, inflamed areas that often contain fluid and can become very painful.
Questions to Ask Your Doctor
- Is this lesion a nodule or an abscess, and what does that mean for treatment?
- What are my options if the pain becomes severe?
- When should I seek care for drainage, infection, or worsening symptoms?
- Are medications or injections appropriate for recurring abscesses?
What You Can Do
- Rate your pain daily using a 0–10 scale to show how it changes.
- Write down whether the bump grows, softens, or drains over time.
- Note how pain affects daily activities like walking, sitting, or sleeping.
What May Bring Relief Right Now
- Listen to your pain. If something hurts, it’s okay to rest or change positions — pain is information, not weakness.
- Ease pressure where you can. Adjusting how you sit, move, or sleep may reduce discomfort.
- Try warmth if it helps. Some people find warm compresses comforting — stop if pain increases.
- Protect sensitive skin. Soft, non-stick dressings can help if the area feels fragile or irritated.
Tunnels or Tracts (Skin Tunnels)
Tunnels form under the skin and may connect multiple lesions, sometimes opening to the surface.
Questions to Ask Your Doctor
- Do I have tunnels, and how can you tell?
- What treatments help stop tunnels from forming or worsening?
- Should I see a dermatologist or surgeon with HS experience?
- Are imaging tests ever helpful for assessing tunnels?
What You Can Do
- Track how often drainage occurs and from where.
- Note whether tunnels feel constantly active or flare intermittently.
- Keep a timeline of when tunnels first appeared and how they’ve changed.
What May Bring Relief Right Now
- Focus on gentle care. Keeping the area clean with mild, fragrance-free products can help protect sensitive skin.
- Protect open or draining spots. Soft dressings may help reduce irritation and manage drainage.
- Avoid tight clothing or pressure. Giving the skin room can make a noticeable difference.
- Trust your instincts. If something feels “off” — increasing pain, redness, or fever — it’s okay to seek care sooner.
Thick Scarring and Skin Changes
HS can leave behind scars, discoloration, or tight skin even after active inflammation settles.
Questions to Ask Your Doctor
- Are these scars permanent, or can they improve over time?
- What treatments can help reduce scarring or skin thickening?
- Does scarring mean my HS is progressing?
- How can we prevent new scars during future flares?
What You Can Do
- Photograph healed areas to track changes in color or texture.
- Note sensations like tightness, pulling, or reduced movement.
- Track how often flares occur in the same scarred locations.
What May Bring Relief Right Now
- Give scarred skin a little extra care. Using a gentle, fragrance-free moisturizer can help skin feel more comfortable and less tight.
- Go easy on areas that rub. If certain clothes or movements cause irritation, adjusting fabrics or fit may help reduce discomfort.
- Move in ways that feel kind to your body. Gentle stretching can help if scars feel tight but stop if anything hurts.
- Protect healing skin during flares. Being mindful of friction, pressure, or irritation can help prevent added discomfort while the skin is sensitive.
Oozing or Draining Pus
Drainage can happen when abscesses rupture, often releasing cloudy or blood-tinged fluid.
Questions to Ask Your Doctor
- Is this type of drainage typical for HS?
- How should I care for draining lesions at home?
- When does drainage signal an infection that needs treatment?
- Are there treatments to reduce how often lesions drain?
What You Can Do
- Record how often drainage occurs and how long it lasts.
- Note the amount, color, and thickness of fluid (for your reference).
- Track whether drainage happens during flares or continuously.
What May Bring Relief Right Now
- Protect your skin (and your clothes). Absorbent, non-stick dressings can help manage drainage more comfortably.
- Change dressings as needed. Keeping the area clean and dry may help reduce irritation.
- Be gentle with cleansing. Mild soap and water are usually enough — harsh products can make skin irritated.
- Know when to get help. Fever, worsening pain, or spreading redness are reasons to reach out for care.
Pain or Tenderness in Affected Areas
Pain may range from mild sensitivity to severe, disabling discomfort.
Questions to Ask Your Doctor
- What options exist for managing HS-related pain?
- How do we treat pain during flares versus between flares?
- Could nerve pain or inflammation be contributing?
- When should pain prompt a treatment change?
What You Can Do
- Keep a daily pain log using simple descriptors (throbbing, burning, aching).
- Track pain patterns (morning vs. night, movement-related, or constant).
- Note what helps or worsens pain (heat, friction, stress, activity).
What May Bring Relief Right Now
- Reduce friction wherever possible. Small changes, like wearing looser clothing and softer fabrics, can make a big difference.
- Try heat or cooling if it feels comforting. Everyone is different; go with what soothes your body.
- Pace yourself during flares. It’s okay to slow down when pain is high.
- Acknowledge what you’re feeling. Pain is a real symptom of HS — and it deserves attention.
Unusual Odor
Odor is a common, but often unspoken, HS symptom linked to drainage and inflammation — not hygiene.
Questions to Ask Your Doctor
- What causes odor in HS, and how can it be managed?
- Are there topical treatments or wound-care strategies that help?
- Could infection be contributing to the odor?
- How can I reduce odor during active flares?
What You Can Do
- Track when odor occurs: during drainage, flares, or continuously.
- Note whether odor changes with certain dressings or hygiene routines.
- Document how odor affects daily life, so your healthcare provider understands its impact.
What May Bring Relief Right Now
- Remember: this is not about hygiene. Odor is part of the disease process, not something you caused.
- Manage drainage gently. Changing dressings regularly may help reduce odor and irritation.
- Stick with mild, unscented products. Strong fragrances can sometimes worsen skin irritation.
- Give yourself grace. You’re not alone, and help is available.
Why Tracking Symptoms Matters
HS symptoms don’t just come and go — they tell a story over time. Writing things down, noticing patterns, and bringing specific questions to your appointments can help your healthcare provider see the full picture, not just what’s visible that day.
You deserve care that recognizes how HS affects your body, your comfort, and your quality of life. Conversations with your doctor should help you feel heard rather than rushed.
How Doctors Describe HS Severity: The Hurley Staging System
If you’ve ever heard your doctor mention “Hurley stage” when talking about your HS, they’re using a clinical tool called the Hurley Staging System. It helps healthcare providers describe how widespread HS is and how deeply it’s affecting the skin — not how well you’re coping or how “bad” you’re doing.
Importantly, people can move between stages over time, especially with early diagnosis and appropriate treatment.
Hurley Stage 1: Small, Isolated Lumps
At this stage, HS often looks like:
- Single or occasional painful bumps
- Lesions that may come and go
- No tunnels (sinus tracts) under the skin
Many people at this stage are told they have recurring boils, ingrown hairs, or acne — which can delay diagnosis.
Why this stage matters:
Early treatment at Stage 1 may help reduce flares and lower the risk of developing tunnels or scarring later.
Hurley Stage 2: Recurring Abscesses and Tunnel Formation
Stage 2 HS is marked by:
- Repeated abscesses in the same areas
- Formation of tunnels (sinus tracts) under the skin
- Lesions that may drain, heal slowly, and return
Pain, drainage, and scarring often become more noticeable at this stage.
Why this stage matters:
Once tunnels form, HS becomes harder to manage and often requires more targeted or combination treatments.
Hurley Stage 3: Widespread Tunnels and Scarring
Stage 3 HS involves:
- Large areas of affected skin
- Interconnected tunnels beneath the surface
- Significant scarring and skin changes
- Ongoing drainage, inflammation, and pain
Daily activities, mobility, and quality of life can be significantly affected.
Why this stage matters:
Stage 3 HS carries a higher risk of chronic pain, infection, and permanent scarring — and often requires specialized dermatologic or surgical care.
How Hurley Stages Connect to Symptoms
The symptoms you experience — painful bumps, tunnels, drainage, odor, scarring, and tenderness — are all signs of ongoing inflammation. Over time, if inflammation isn’t well controlled, symptoms may:
- Last longer
- Become more painful
- Spread to new areas
- Lead to permanent skin damage
This is why tracking symptoms and discussing changes early with your doctor can be so important.
Questions to Ask Your Doctor About Hurley Staging
- What Hurley stage am I in right now?
- Can my stage change with treatment?
- How does my current stage affect my treatment options?
- What signs should I watch for that suggest my HS is progressing?
What You Can Do as a Patient
- Keep a simple log of new bumps, drainage, tunnels, and pain levels.
- Note whether lesions are isolated or connected under the skin.
- Bring photos or written notes to appointments to show changes over time.
A Final Word of Reassurance
Living with ongoing skin symptoms can be confusing, frustrating, and sometimes isolating, especially when they don’t fit neatly into a box or come with clear answers right away. Painful bumps, drainage, scarring, tenderness, or odor can affect not just your skin, but your comfort, confidence, and day-to-day life.
Whether your symptoms are mild or severe, occasional or constant, what you’re experiencing matters. Noticing patterns, changes, and how these symptoms affect you gives you important information — and it gives your healthcare provider a clearer picture of how to help.
If you’re still searching for answers, it’s okay to ask questions, seek another opinion, or bring notes and photos to your appointment. And if you’ve already been told you have hidradenitis suppurativa, understanding your symptoms can help you advocate for care that fits your life.
Most importantly, this is not your fault — and you deserve care that listens, takes your symptoms seriously, and works with you to find relief.
Try the HS Check now. Start here.
This article was made possible with support from UCB.
