Hidradenitis suppurativa stage 3 is the most advanced form of the skin condition. Symptoms include widespread abscesses, scarring, and tunneling wounds called sinus tracts.

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin condition that causes abscesses, nodules, sinus tracts, and scarring.

This article looks at the symptoms, causes, diagnosis, treatment, and outlook for stage 3 HS.

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Stage 3 HS is the most advanced stage of the disease, with the most severe symptoms.

Healthcare professionals use the Hurley staging system to classify the severity of HS as mild, moderate, or severe. There are three stages of HS based on which symptoms are present:

  • Stage 1: In stage 1, people have abscesses but no scarring or sinus tracts, which are tunneling wounds under the skin.
  • Stage 2: In stage 2, people have persistent abscesses, sinus tracts, and scarring. People may have single lesions or multiple lesions that are widely spread out.
  • Stage 3: Abscesses cover a widespread area, with few to no areas of unaffected skin between them. People may have multiple interconnected sinus tracts.

Symptoms may include:

  • abscesses, which are fluid-filled bumps that may break open and release odorous pus and blood
  • spots that look like blackheads and usually occur in pairs
  • sinus tracts, which are tunnels under the skin
  • scarring

The American Academy of Dermatology notes that HS may develop in the following way:

  1. Keratin, a protein present in the skin, nails, and hair, blocks a hair follicle.
  2. Bacteria develop inside the follicle as keratin and sweat build up.
  3. The hair follicle bursts, resulting in a pimple or an abscess.
  4. The leaking substance from the burst follicle spreads to other nearby follicles, causing more lumps to develop.
  5. Follicles continue to become blocked and burst open, causing tunnels to form deep within the skin.

Over the years, scarring can develop, which can limit a person’s movement.

It is important to note that HS is not a result of inadequate hygiene, and it is not contagious.

Although there is no clear cause of HS, some risk factors may increase a person’s risk of developing the condition, including:

  • having a parent or sibling with HS
  • having overweight or obesity
  • having metabolic syndrome
  • smoking

HS is more common in females, which may suggest a hormonal cause. People may develop HS between puberty and menopause.

Stage 3 HS involves widespread areas of abscesses and nodules, so a doctor may be able to diagnose the condition through a physical examination and assessment of symptoms.

Imaging is not typically helpful for this diagnosis. However, ultrasound may be a useful tool to identify the extent of sinus tracts before surgery.

Regardless of the disease stage, lifestyle changes and general treatment strategies are important parts of HS treatment.

These can include:

  • reaching or maintaining a healthy BMI
  • eating a healthy, balanced diet
  • quitting or avoiding smoking
  • wearing loose-fitting clothing
  • following a skin care plan
  • applying warm compresses to soothe the skin
  • applying topical antiseptics
  • using a gentle antibacterial soap to wash the skin

Managing any mental health concerns can also be an important part of treatment. The severe symptoms of stage 3 HS may affect a person’s quality of life and cause problems such as:

  • social isolation
  • missed days of work due to flare-ups
  • difficulties with relationships and sex

Counseling and support groups may help people navigate the mental, emotional, or social challenges of the condition.

A person can find support groups using the Hidradenitis Suppurativa Foundation’s website.

Medical treatment

A doctor or dermatologist may prescribe the following medications for stage 3 HS:

  • oral retinoids
  • immunosuppressive agents
  • biologics
  • topical antibiotics

For widespread HS, oral antibiotics may help reduce inflammation. People may need to take antibiotics for 2–3 months or longer. A doctor may prescribe a combination of two antibiotics, clindamycin and rifampin, to treat severe HS.

Surgical procedures are usually necessary to treat stage 3 HS. Possible procedures include:

  • Incision: A healthcare professional may make an incision into an abscess to drain it.
  • Local excision: This procedure involves removing the abscesses, nodules, and sinus tract.
  • Deroofing: A healthcare professional will remove the skin on the top of an abscess or sinus tract.
  • Radical excision: This is the surgical removal of an entire affected area.
  • Laser and light therapy: This procedure involves using heat and light to destroy abscesses, nodules, and sinus tracts. It may help manage inflammation.

Laser hair removal can also help treat HS. It can destroy the causative hair follicle so HS does not develop in that area.

Skin care

Caring for the skin that HS affects is an important part of managing the condition. A skin care routine can help limit any injury to the skin. A dermatologist may recommend:

  • avoiding use of harsh cleaning products
  • avoiding scrubbing the skin or using abrasive items such as loofahs
  • avoiding adhesive dressings and instead using a soft dressing with petroleum jelly

The following skin care tips may help a person manage HS symptoms:

  • using an antimicrobial wash
  • avoiding waxing, and taking care if shaving affected areas
  • treating painful nodules with a warm compress by soaking a clean washcloth in black tea or warm water, wringing it out, and placing it on the skin for 10 minutes, as necessary
  • staying in cool areas as much as possible to help reduce sweating and overheating, which may worsen HS
  • using a mild, effective antiperspirant or deodorant with no harsh chemicals

If a person wishes to remove body hair, laser hair removal may be preferable to waxing or shaving.

Learn more about how to care for HS at home.

People will need treatment for HS. Although there is currently no cure for HS, treatment can help reduce symptoms and prevent the disease from progressing. Without prompt treatment, the outlook may worsen.

Addressing any contributing factors, such as smoking or obesity, is an important part of managing the condition.

HS is not usually life threatening, but in some cases, people may develop a severe infection, which could be dangerous. Managing HS with treatment and self-care may help prevent severe complications.

Treatment may also limit scarring, which can help a person maintain their usual movement.

A person will need to contact a doctor as soon as possible if they have any symptoms of HS.

A healthcare professional can help a person manage the symptoms of stage 3 HS. Prompt diagnosis and treatment may reduce the risk of complications and long-term damage.

A person will also need to talk with a doctor if they have any worsening symptoms.

HS is a chronic, inflammatory skin condition that causes abscesses on the skin. The disease has three stages based on the severity of symptoms.

Stage 3 HS is the most advanced stage of the disease. In stage 3 HS, people have sinus tracts and scarring. Abscesses are widespread, with little unaffected skin between them.

If a person may have HS, it is important to get treatment as soon as possible. Treatment for stage 3 HS may include medications, skin care, lifestyle strategies, and surgery.