# Hidradenitis suppurativa explained simply

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Language: en
Category: Basics
Published: 2026-05-21
Last updated: 2026-05-22
Author: Dr. rer. nat. Dennis Alexander Kwiatkowski (Biochemist, Scientific Writer and Pharma Expert)
Tags: Acne Inversa, Hidradenitis Suppurativa, HS, Basics, acne inversa, hidradenitis suppurativa, explained simply, basics

> A clear explanation for patients, family members and people hearing about Hidradenitis suppurativa for the first time: what the condition is, how it can present and what is not true about it.

Medical disclaimer: This website is for general educational information only and does not replace medical advice, diagnosis, or treatment. Please speak with qualified medical professionals about symptoms or treatment decisions.

## Article

## The most important points first

- **Acne Inversa** is usually referred to in the medical literature as **Hidradenitis suppurativa**, or **HS** for short.
- HS is a chronic inflammatory skin disease, not a question of poor hygiene.
- A pattern of recurrent painful lesions at specific body sites is typical.
- A single lump does not prove HS. The course, location and examination belong together.

These four points are a good starting point if the term is new to you. They
also help to describe symptoms factually, without trivialising them or
diagnosing yourself too quickly.

## The short explanation

In HS, inflammatory skin changes develop that sit deep and can be very
painful. These include nodules, abscesses, weeping lesions, tunnels under the
skin and scars. Not all signs have to be present at the same time. Especially
in the early stages, the picture can still appear limited.

Frequently affected areas are the armpits, groin, genital and perineal region,
buttocks and skin folds under the breasts. What matters is not just how a site
looks on a single day. What matters is the recurrent pattern.

## Why the name can be misleading

Many people associate the word "acne" with superficial pimples on the face.
That fits poorly with Acne Inversa. The German guideline explicitly describes
HS as something different from acne vulgaris: in HS, deep inflammatory
lesions, typical regions and possible tunnel formation or scarring take
centre stage.

This matters because misleading mental images can stand in the way of asking
the right question. Otherwise, recurrent abscesses are treated as a series of
isolated events. Or those affected blame themselves, even though HS is not
caused by a lack of hygiene.

## How doctors recognise the pattern

The diagnosis is made primarily clinically. That means: the examination and
medical history count. The medical assessment asks in particular about:

1. **Lesions:** Are there deep painful nodules, abscesses, tunnels or
   scars?
2. **Location:** Do they occur in typical regions such as the armpits, groin,
   genital area, perineum, buttocks or under the breasts?
3. **Course:** Do the symptoms come back or do changes remain?

A single inflamed hair follicle can occur without HS being behind it.
Conversely, a recurrent pattern should not be played down just because a
flare temporarily subsides.

## What HS can mean in everyday life

HS is not "just skin". Depending on the location, pain can make walking,
sitting, raising the arms, sleeping or getting dressed more difficult.
Discharge can affect clothing, wound care and worries about odour. Lesions in
the intimate area can intensify feelings of shame, withdrawal or strain in
closeness and sexuality.

These effects belong in a conversation with the doctor. They show not only
that a lesion is present, but also what disease burden lies behind it.

## What you can note down before an appointment

A brief note is often enough:

| Question | Example of your own note |
| --- | --- |
| Where does it occur? | "right armpit and groin fold" |
| How does it progress? | "three similar episodes since January" |
| What is left behind? | "a scar, recurring opening, discharge" |
| What is becoming more difficult? | "sitting, sport, sleep or wound care" |

If a flare has subsided by the time of the appointment, photos of the course
can be helpful. They do not replace an examination, but they make recurrence
and severity more visible.

## When the introduction should become a conversation with the doctor

Speak about your symptoms if you repeatedly have painful nodules or abscesses
in typical regions, if sites weep or leave scars, or if pain noticeably
restricts your everyday life. A clear description might be, for example:
"For months I have been getting recurring deep painful nodules in the groin.
Some open up, and at one spot a scar remains."

In the case of fever, rapid deterioration, strongly increasing redness or
very severe pain, prompt medical help is important. This article helps with
understanding, but does not replace a diagnosis.

## FAQ

### Is Acne Inversa the same as Hidradenitis suppurativa?

Yes. Hidradenitis suppurativa, or HS for short, is the term commonly used in the medical literature for the condition often called Acne Inversa in German-speaking countries.

### Is Hidradenitis suppurativa just acne in a different part of the body?

No. HS is a chronic inflammatory skin disease with recurrent deep lesions in typical regions. It is not described in the same way as ordinary acne vulgaris with superficial pimples.

### When should I speak to a doctor about recurrent lumps?

Recurrent painful lumps, abscesses, weeping lesions or scars in typical regions such as the armpits, groin, genital area, buttocks or under the breasts should be assessed by a dermatologist.

## References

1. S2k guideline for the treatment of Hidradenitis suppurativa / Acne inversa - AWMF, 2024 - https://register.awmf.org/assets/guidelines/013-012l_S2k_Therapie-Hidradenitis-suppurativa-Acne-inversa_2024-08.pdf
2. North American clinical management guidelines for hidradenitis suppurativa, Part I - Journal of the American Academy of Dermatology, 2019 - https://pubmed.ncbi.nlm.nih.gov/30872156/
3. Hidradenitis suppurativa - Nature Reviews Disease Primers, 2020 - https://pubmed.ncbi.nlm.nih.gov/32165620/