Hidradenitis suppurativa (HS) is a skin condition marked by painful acne-like boils that develop deeply under your skin.

You will likely experience recurring symptoms over a long time if you are a chronic condition like hs. It is important to treat the condition in its earliest stages as it can cause other problems.

Unlike acne, which primarily affects the sebaceous glands, HS develops in your sweat (apocrine) glands. While HS isn’t the same as acne, many of the developing characteristics are similar.

Hairs trapped in hair follicles cause inflammation in the skin. Mild infections may occur when the follicles are trapped by the bacterium. The lesions can become painful and eventually break.

The presence of these glands is a factor that can lead to the diagnosis of HS. It is often broken down into three stages. The system is called the Hurley staging. The sooner you get treatment, the better.

The staging system was introduced by a dermatologist. It was intended to allow doctors to quickly identify the appropriate treatments for the symptoms of the disease based on the severity of the boils.

A study from 2019 asked dermatologists, plastic surgeons, and general surgeons to select Hurley stages using photos alone. They found that the staging was most reliable for Hurley stage 3 and required very little time to assess — around 14 seconds.

“The researchers think that this shows that staging can be useful even when healthcare professionals can’t complete a more thorough examination.”

The simplicity of this assessment is what makes it one of the most used instruments for assessing. The Sartorius Hidradenitis Suppurativa Score is one of the staging instruments.

Hurley stage 1 is the mildest clinical form of this condition. It’s marked by isolated boils that sometimes form in multiples, but without tunnel (sinus tract) formation. This stage doesn’t cause widespread abscesses or scarring that more severe HS can.

Milder cases of HS may be treated with home remedies. These include washing with antibacterial soaps, applying warm compresses, avoiding shaving, staying dry, and using antiseptics. A doctor may also recommend taking an anti-inflammatory medication.

Mild HS can be treated with a steroid cream or injections. The boil and tracts may decrease in size and severity if these help to decrease inflammation. Stage 1 will likely develop into stage 2 if left unaddressed.

Seen here are multiple abscesses, without sinus tracts and scarring, which is still considered stage 1.

In stage 2 of the Hurley stage, you may experience more moderate abscesses that may appear in more widespread areas of your body. The skin can become more sore and break open if the boil is not removed. Tract formation is possible in this stage, but it is not as great as in stage 3.

If topical remedies haven’t worked alone, a doctor may also prescribe oral steroids or antibiotics. These are taken temporarily to help decrease inflammation and bacterial buildup, respectively. Pain relievers may also be recommended.

Shown are multiple abscesses, with sinus tract formation and scarring.

The most severe form of the disease is called Hurley stage 3. It is characterized by a more widespread development of the HS. In this stage, there will be pain and scarring.

Due to this widespread and recurring nature, stage 3 can be very difficult to treat. Boils, tracts, and scars may be removed via surgery, especially if HS is starting to interfere with your quality of life. Laser therapies and hair removal may also help. Immunosuppressant drugs like adalimumab (Humira) may be used for severe cases, too.

This is diffuse or nearly diffuse involvement of the affected region, with multiple interconnected tracts and abscesses across the entire area.

It’s estimated that HS affects at least 1 out of every 100 people. HS is thought to have a strong genetic component, so you may have a higher risk if you have family members with this condition. It tends to develop during teenage and early adult years. Women are at a higher risk of developing HS, but it can occur in men, too.

Certain health conditions can increase your risk of developing HS. These include:

It is important to know that having any of the above conditions does not mean you will develop HS. It is important to keep an eye on your skin if you have any signs of a boil.

It can be difficult to treat and further complicating the condition can affect your daily life.

You may experience significant pain, which may be further compounded when you walk or move around due to the nature of the boil being located in skin folds. There are more complicated problems in stage 3.

Infections can be caused by widespread lesions. A weakened immune system can lead to a life threatening bacterial infection.

Having HS can also increase your risk of social isolation and missed days of work. It may even lead to anxiety and depression.

Many people with HS may not seek medical help right away. This is sometimes due to a previous misdiagnosis of cystic acne or other chronic skin conditions. Unlike traditional acne though, HS tends to recur in the same areas and it won’t respond to over-the-counter treatments.

If you have any of the following skin conditions, talk to a doctor.

  • The folds of your skin can be the site of boil-like lesions.
  • There are lesions that recur in the same area.
  • The sides of your body are affected by symmetrical boils.
  • Areas of skin that are very painful and interfere with your daily activities.

It is important to seek treatment as soon as possible because there is no cure for the disease. This will help decrease the inflammation andbacteria that can make this skin condition worse.

Treatments can help reduce pain and scarring, which can improve your quality of life. The treatment measures may be more aggressive if your HS is more severe.

“If you find that your current treatment isn’t improving your skin, you may need to see a specialist like a dermatologist or even a surgeon.”