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:
- Lesions: Are there deep painful nodules, abscesses, tunnels or scars?
- Location: Do they occur in typical regions such as the armpits, groin, genital area, perineum, buttocks or under the breasts?
- 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
- S2k guideline for the treatment of Hidradenitis suppurativa / Acne inversa AWMF, 2024
- North American clinical management guidelines for hidradenitis suppurativa, Part I Journal of the American Academy of Dermatology, 2019
- Hidradenitis suppurativa Nature Reviews Disease Primers, 2020
