Hidradenitis suppurativa (HS) stage 2 involves abscesses, tunneling wounds, and scarring. Various treatments, including lifestyle changes and medications, can help prevent the condition from worsening.

HS is a chronic skin condition that causes abscesses and nodules to form on areas of the skin, such as the armpits, groin, and around the genitals.

There are three stages of HS, which vary in severity. This article outlines the symptoms, diagnosis, and treatment of HS stage 2.

A person with arms above their head exposing the armpit.Share on Pinterest
Tania Cervian/Stocksy

According to a 2019 study, the Hurley staging system is one of the most common methods for assessing the severity of HS. There are three stages of HS, with stage 1 being the mildest and stage 3 being the most severe.

The Hurley staging system defines stage 2 HS as:

  • recurrent abscesses
  • sinus tracts, which is a passageway or tunnel leading from a wound under the skin through soft tissue
  • scarring
  • single or widely separated lesions

Learn more about HS.

Symptoms of HS stage 2 may include:

  • open comedones — pores containing skin debris and oil
  • firm papules and nodules, which may be painful
  • pustules and abscesses
  • sinus tracts
  • raised or indented scars

In stage 2, sinus tracts and scarring are also present. HS usually forms in areas where skin touches skin, such as the armpits or inner thighs.

The following images show examples of how HS stage 2 may look.

Experts are still unclear of the exact cause of HS but know that the disease begins in hair follicles.

Sweat, bacteria, and a protein called keratin can clog the hair follicles and cause them to burst. This results in nodules and abscesses that can lead to scar formation. Over time, sinus tracts may develop in the skin and may lead to infections.

The following factors may increase the risk of developing HS:

  • family history of HS
  • exposure to triggers, such as smoking or excess weight
  • being female, which may be due to hormonal reasons
  • being between puberty and age 40
  • being biracial, African American, or Hispanic
  • having psoriasis

There are no specific tests to diagnose HS. Doctors will examine symptoms and may perform tests to rule out other conditions, such as:

  • a biopsy check for squamous cell carcinoma if symptoms are severe
  • taking a bacterial culture to check for any secondary infection or other possible cause

Imaging scans, such as ultrasound, may help a doctor examine any sinus tracts to determine their severity.

Treatment for HS stage 2 may include lifestyle changes, medications, and surgical procedures. Treatment may help prevent HS worsening.

Lifestyle changes and home treatment for HS may include:

Skin care tips

The American Academy of Dermatology Association (AAD) recommends people with HS can care for the skin by:

  • Using an antimicrobial wash to gently wash affected areas to decrease bacteria, which may help reduce flare-ups.
  • Opting for skin washes containing benzoyl peroxide or zinc pyrithione.
  • Avoiding scrubbing the skin, as this may inflame the area — HS is not due to unclean skin or hygiene.
  • Avoiding squeezing or popping any nodules or cysts, as this may create more irritation or injury to the skin.
  • Taking extra care if shaving to avoid cuts in the skin, which may lead to infection. Wash the area beforehand with antibacterial soap and use a gel-to-foam gel to shave with.
  • Avoiding waxing, as this may irritate the skin and worsen HS.
  • Considering laser hair removal. This may reduce hair follicles and bacteria on the skin, as well as the activity of the sebaceous glands, which may reduce HS flare-ups.
  • Applying a warm compress to HS, using a clean cloth dipped in warm black tea or warm water and pressing to the skin.
  • Avoiding overheating and excess sweating, as this may worsen symptoms.
  • Using a mild deodorant or antiperspirant to prevent sweating. It should not contain ingredients that may irritate HS, such as alcohol, dyes, fragrances, baking soda, or parabens.
  • Following any wound care guidance from a healthcare professional.
  • Wearing loose-fitting clothing to help prevent skin irritation.

Medical treatment

Medical treatment for HS may include:

  • Topical treatments: For HS, these may contain benzoyl peroxide, triclosan, or clindamycin phosphate.
  • Topical antibiotics: These include fusidic acid, dapsone, clindamycin, or metronidazole.
  • Antibiotics: To treat bacterial infections, people may take tetracyclines. Other options include longer courses with combination drugs, such as clindamycin with rifampicin or tetracyclines with rifampicin.
  • Hormonal therapies: This may include estrogens, anti-androgens, or leuprolide acetate.
  • Immunomodulators: People may have steroids for acute flare-ups and steroid-sparing agents, such as ciclosporin, methotrexate, or azathioprine.
  • Biologics: Adalimumab (Humira) is the only biologic the Food and Drug Administration (FDA) has approved for treating HS.

People may require medical procedures to treat abscesses and skin tracts with stage 2 HS. These may include:

  • incision and drainage of abscesses
  • surgical removal of persistent abscesses, nodules, or sinus tracts
  • radical excision, which is the surgical removal of an affected area
  • laser ablation, which uses heat and light to remove nodules, abscesses, and sinus tracts
  • laser hair removal

Read about surgical procedures to treat HS.

Treatment is necessary for HS and may help to reduce lasting damage.

There is currently no cure for HS, but treatment can help manage symptoms and may help prevent the condition from worsening.

According to a 2018 article, people whose HS advanced rapidly from stage 1 to 2 were more likely to experience progression to stage 3.

The article cited previous research spanning an average of 22 years. Of 121 people with HS, 39% reported remission, 32% reported improvement, 21% reported no change in severity, and 9% reported worsening.

According to an older study, people with HS may reach their maximum disease severity after around 6.4 years of experiencing the first symptoms.

Researchers found that people with HS stages 1 and 2 had unchanging disease severity for around 6–9 years, suggesting they may be unlikely to progress to more severe stages.

Stage 1 is the mildest form of HS, consisting of abscesses but no sinus tracts or scarring.

Stage 3 is the most severe form of HS, involving multiple affected areas, abscesses covering a wider area, and multiple interconnected sinus tracts.

If people have symptoms of HS, they must contact a doctor as soon as possible.

Early diagnosis and treatment are important in helping to reduce long-term damage and may help reduce symptoms and prevent the condition from progressing.

If people have any stage of HS and think their symptoms are worsening, they must contact a doctor.

There are three stages of HS. Stage 1 is the mildest, and stage 3 is the most severe. People with stage 2 HS may have abscesses, sinus tracts, and scarring.

Seeking early diagnosis and treatment for HS is essential to help manage symptoms and prevent the disease from worsening.

Treatments for HS stage 2 may include lifestyle changes, medications, and medical procedures.