Hidradenitis Suppurativa on the Face: What You Need to Know

Hidradenitis suppurativa, or HS, is a skin condition that causes painful, swollen bumps to form. These bumps usually pop up around hair follicles and sweat glands—like under your arms or between your thighs—especially in spots where your skin rubs together.

In some rare cases, hidradenitis suppurativa on face can also show up. When that happens, it might affect how you feel about your appearance, especially if the bumps are big or there are a lot of them.

These lumps can get really sore and swollen as pus builds up inside. Without treatment, they might turn hard and leave behind thick scars or even tunnels under your skin.

At first glance, Hidradenitis suppurativa can look a lot like acne, and sometimes people have both at the same time. They both start with inflammation in hair follicles, but there’s one key difference—HS often leaves rope-like scars, while acne usually doesn’t.

To help discover better treatment options, clinical trials on hidradenitis suppurativa are currently underway, offering individuals the opportunity to enroll and explore potential solutions.

Facial Hidradenitis Suppurativa (HS) Symptoms

HS on face can occur alone or with HS in other common areas. It may show up alongside bumps in the armpits, groin, or other areas where skin rubs together—or, in rare cases, only on the face.

Facial HS is often mistaken for acne. If HS only appears on the face, it can be easy to confuse it with regular acne, especially in the early stages.

The bumps may look like pimples. HS causes nodules, boils, or abscesses that closely resemble acne breakouts.

HS and acne are different conditions. Even though HS is sometimes called “acne inversa,” it’s not the same as common acne (acne vulgaris). However, both conditions can occur at the same time. If you’re dealing with acne, you might also be interested in exploring clinical trials on acne to discover targeted treatment options.

They share similar symptoms but have different causes. While both involve inflammation and may look alike, HS and acne have distinct genetic backgrounds and risk factors.

Facial Hidradenitis Suppurativa: Possible Complications

Scarring is the most common complication. HS can leave behind thick scars. In severe cases, scarring can block fluid drainage in the skin.

Severe facial scarring is rare. Although scarring is common with HS, serious facial scarring that causes disfigurement doesn’t happen often.

Swelling may occur in rare cases. Scar tissue buildup can sometimes lead to swelling in affected areas.

Other physical complications may include:

• Ongoing (chronic) infections
• Joint pain
• Skin inflammation

It can affect your emotional well-being. Nearly 30% of people with HS have experienced depression or anxiety.

In one study, 100% of participants said their HS symptoms affected their emotional or physical health.

Over 80% said that scars and skin damage led to emotional distress.

Facial HS may cause more emotional stress than HS in other areas. The visibility of the bumps and scars on the face can make social situations more difficult and impact self-confidence.

Some treatments can have side effects. A 2022 study found that about 11% of people experienced complications from treatment.

Certain surgical procedures carry higher risks than others.

Over 16% of people who have surgery may see their HS return afterward.

What Causes HS on the Face?

The exact cause of hidradenitis suppurativa on face isn’t fully understood, but certain factors can increase your risk of developing it — including on the face. These may include:

• Genetics – Is HS genetic? Having a family history of HS can make you more likely to develop it.
• Smoking – Tobacco use is strongly linked to HS flare-ups.
• Being overweight – Extra weight can increase skin friction and inflammation, triggering symptoms.
• Certain medications – Drugs like lithium (used for mood disorders) have been associated with HS.
• Shaving sensitive areas – Shaving spots like the armpits or groin may lead to an earlier onset of the disease.

It’s important to remember that HS is not caused by poor hygiene and it’s not contagious—you can’t catch it from someone else or spread it by touch.

How Is Hidradenitis Suppurativa Diagnosed?

Hidradenitis suppurativa (HS) is often mistaken for acne or regular pimples, which can delay an accurate diagnosis—sometimes for years.

To diagnose HS, your healthcare provider will look at:

• Your symptoms
• The appearance of your skin
• Your medical history

You may also be referred to a dermatologist—a doctor who specializes in skin conditions—for a closer evaluation, especially since HS can be tricky to diagnose and needs expert care.

There isn’t a specific lab test to confirm HS. However, if there’s pus or fluid draining from a bump, your provider might take a sample to rule out an infection or other issues.

Classifying Severity: The Hurley Staging System

HS severity is often categorized using the Hurley staging system:

• Stage I: Mild—isolated lumps with no tunnels or scarring.
• Stage II: Moderate—recurrent lumps, some tunnels, and scarring.
• Stage III: Severe—widespread lumps and extensive tunnelling.

Understanding your HS stage helps doctors tailor treatment, especially when HS appears on the face.

Treatment Options for Hidradenitis Suppurativa on the Face

Treating HS on face can be a bit more sensitive due to the skin’s visibility and delicacy. The goal of treatment is to reduce inflammation, manage pain, prevent new flare-ups, and minimize scarring.

Here are some common treatment options:

1. Topical Treatments

Antibiotic creams or gels may help reduce inflammation and prevent infection. Often used for mild cases or early flare-ups.

2. Oral Medications

Antibiotics may be prescribed to fight infection and inflammation.

Anti-inflammatory drugs like corticosteroids may be used for short-term symptom relief.

Hormonal therapy may help some people, especially women with hormone-related triggers.

Immunosuppressants or biologics (like adalimumab) may be used in moderate to severe cases to calm the immune response.

3. Warm Compresses and Gentle Skincare

Warm Compress – Applying a warm compress can reduce pain and swelling.

Gentle Cleansers – Use gentle cleansers and avoid scrubbing or picking at bumps to prevent irritation.

4. Laser or Light Therapy

Laser treatments may help shrink or destroy hair follicles that trigger HS. These options are less invasive and may reduce flare-ups over time.

5. Surgery (for Severe Cases)

Minor surgical procedures may be done to drain abscesses or remove scar tissue. Surgery is usually considered when other treatments haven’t worked or if the condition is advanced.

6. Lifestyle Support

Quit smoking – Smoking can worsen HS symptoms.

Maintain a healthy weight – Reducing friction between skin folds can help.

Stress management – Since stress can trigger flare-ups, finding ways to manage it may help reduce symptoms.

Lifestyle Tips and Home Remedies for HS on the Face

While there’s no cure for hidradenitis suppurativa on face, certain lifestyle changes and home care strategies can help manage symptoms, reduce flare-ups, and slow the condition’s progression—especially when it affects the face.

Daily Habits That May Help

• Consider Laser Hair Removal: Shaving can irritate the skin and trigger flare-ups. Laser hair removal offers a longer-term solution by reducing hair growth and inflammation around the follicles.
• Quit Smoking: Smoking is linked to both the development and worsening of HS. Quitting may help reduce the number and severity of flare-ups.
• Maintain a Healthy Weight: Excess weight increases friction in skin folds and may worsen inflammation. Even small changes in diet and physical activity can support healthier skin.
• Be Gentle with Your Skin: Use mild, non-comedogenic cleansers. Avoid harsh scrubs or picking at bumps, as this can increase irritation and scarring.
• Massage Healed Scars: Once scabs are completely healed, gently massaging scars may help soften the tissue, even out skin tone, and reduce the risk of raised or thickened scars. Use a moisturizer or scar-reducing cream during the massage.

Bonus Tip

Manage Stress – Since stress can trigger inflammation, finding ways to relax—like deep breathing, yoga, or mindfulness—may help keep symptoms in check.

Conclusion

In conclusion, facial hidradenitis suppurativa (HS) is a painful and often misunderstood condition, distinct from acne. Early diagnosis, lifestyle changes, and proper skincare can reduce flare-ups and improve quality of life. HS isn’t caused by poor hygiene and is not contagious. If you suspect facial HS, seek medical advice. Furthermore, MBCP is actively conducting clinical trials on various dermatological conditions, providing individuals with the opportunity to participate and explore potential treatment options.