Hidradenitis suppurativa, commonly referred to as acne inversa, is a chronic skin condition which is difficult and complicated to deal with. Triggered during puberty, teens, or 20s by unhealthy lifestyle habits, this condition is caused by a blockage in the apocrine glands. It is characterized by the appearance of painful bumps under the skin, in the hair roots, or near some sweat glands. They typically occur where skin rubs together, such as in the groin, armpits, and buttocks. The lumps may break open and emit a bad smell or cause tunnels under the skin.

Hidradenitis suppurativa can persist for several years, and this skin condition usually worsens with time. It can impact one’s daily life as well as mental well-being. Therefore, it is vital to diagnose it in time so that a doctor can  recommend appropriate treatment. With the right treatment, one can also prevent the formation of new lumps and other complications such as depression.

Common symptoms of hidradenitis suppurativa
Hidradenitis suppurativa typically occurs in areas surrounding the hair follicles. It may also appear in a single area or multiple parts of the body. Common signs and symptoms of this disease that you should watch out for include:

• Red and tender bumps: The condition is often marked by small and tender red bumps which occur in areas where the skin rubs together. These bumps may become bigger and fill with pus. When this pus drains out, it may emit a bad odor. Itching and a burning sensation often accompany these bumps.
• Blackheads: This is another common symptom of the condition. Small, pitted areas of the skin develop a lot of blackheads that appear in a double-barreled pattern.
• Extremely painful lumps: Small, pea-sized lumps develop under the skin. These lumps may persist for years together, and at some point, may become swollen and inflamed.
• Tunnels: This is the worst symptom where two lumps under the skin get connected through tracts, also known as tunnels. These tunnels may leak pus and take a lot of time to heal.

Hidradenitis suppurativa can start anytime, between puberty and the age of 40. It generally begins with a single bump that is painful and persists for a long time.

Some people experience mild symptoms, whereas others can go through excessively painful signs that affect multiple areas of the body. Certain factors like excess body weight, heat, humidity, and hormonal changes intensify this condition and increase the severity of the symptoms.

Stages of hidradenitis suppurativa
As discussed above, hidradenitis suppurativa generally begins with a single painful lesion in one area. This lesion may heal on its own within one month, or it may break open and release pus.

Slowly, new lumps begin to form. These lumps may vary in size, and they generally grow in size if the condition is not managed well. Narrow sinus tracts or tunnels under the skin may also form which may release pus when ruptured.

As there is no definite way to define the progression of this condition, it is widely categorized into three stages. These stages can be explained as:

• Hurley Stage 1: In this stage, one or a few lesions will appear on the skin, with no sign of any scarring or tunnels.
• Hurley Stage 2: Small pitted areas in the skin will show blisters along with the initial formation of sinus tracts or tunnels.
• Hurley Stage 3: A lot of blisters will appear all over the body, and a network of sinus tracts will form under the skin which may leak pus when cracked.

It is best to click pictures of these lesions at specific time gaps to closely monitor the changes. These pictures can help the doctor in evaluating your condition and determining the stage of the disease.

Most commonly affected areas
The most commonly affected areas include:

• Armpits
• Groin
• Underneath the breasts
• Anus
• Inner thighs
• Buttocks

In the later stages of the disease, the blisters may also spread to the neck, face, back, sides, and waistband region.

When should one see a doctor?
The best way to reduce the impact of the symptoms of hidradenitis suppurativa is by getting an early diagnosis. Therefore, it is vital to get medical help under the following conditions:

• A bump forms that causes intense pain
• The condition doesn’t improve in a couple of weeks
• The bumps recur after a few weeks
• The bumps appear in several areas of the body

Also, if you have hidradenitis suppurativa, it is crucial to know that the signs of recurrence are similar to the original symptoms. If the bumps reappear, it may indicate a severe complication. Therefore, immediate medical consultation is your best bet in such cases.