Signs You’re About to Get an HS Flare-Up

Medical note: This article is for education, not a diagnosis. If you think you have hidradenitis suppurativa (HS) or your symptoms are worsening, a dermatologist or primary care clinician can help you sort out what’s going on.

HS (short for hidradenitis suppurativa) is the kind of condition that loves surprisesmostly the un-fun kind. One day you’re living your life, the next day your armpit is acting like it has a personal vendetta. The good news: many people notice patterns and early “warning signs” before an HS flare-up fully rolls in. Think of it like your skin’s chaotic little weather forecast.

In this guide, we’ll break down the most common signs you’re about to get an HS flare-up, why they happen, what triggers can stack the odds, and what you can do early (before the bump becomes the boss of your whole week). We’ll keep it real, practical, and yeslightly funnybecause sometimes the only thing worse than HS is pretending it’s not frustrating.

Quick HS refresher: what a flare-up actually is (and why it happens)

HS is a chronic inflammatory skin condition that causes painful lumps, nodules, and abscessesusually in areas where skin rubs together: underarms, groin, buttocks, inner thighs, and under the breasts. These lesions can break open and drain fluid or pus, and repeated flares can lead to scarring or tunnels (sinus tracts) under the skin.

Most current explanations point to inflammation that starts around hair follicles. When follicles clog and the area becomes inflamed, pressure builds. The result can be a deep, tender nodule or abscess that hurts like it’s auditioning for a horror movie. Importantly: HS isn’t caused by poor hygiene, and it’s not an STI. Your body isn’t “dirty.” Your immune system is just being extra.

The early warning signs: how HS flares often announce themselves

Not everyone gets the same “heads up,” and some flares arrive like a jump scare. But many people with HS report a predictable ramp-up. Here are the most common signs you’re about to get an HS flare-upplus what they can look or feel like in real life.

1) Itching, tingling, or burning in your usual HS zones

If you’ve ever thought, “Why does my skin feel staticky and offended?”that can be an early flare signal. Itching or tingling may show up before you see a bump. Some people describe it as prickling, stinging, or a low-grade burning sensation, especially in places where they typically flare.

Real-life example: You’re fine all day, then at night your inner thigh starts itching in one exact spot. No rash. No obvious irritation. Two days later? Hello, nodule.

2) A “bruise-like” tenderness when you press (or even when you don’t)

Early HS inflammation can feel like a bruise forming under the skin. You might notice soreness before there’s a visible lump. Sometimes it hurts when you touch it; sometimes it hurts when your shirt sleeve exists near it.

Tip: If you can identify a small, specific tender area early, you may be able to reduce friction and calm the area before it escalates.

3) Warmth, swelling, or redness that looks deceptively minor

Early inflammation can show up as subtle swelling or warmthlike your skin is running a tiny fever in one spot. The redness may be faint at first, especially on deeper skin tones where redness can look more like darkening or a shadowy discoloration.

4) A deep, pea-sized lump that feels “stuck” under the skin

This is a classic HS calling card: a tender, deep nodule that feels like it’s coming from below the surface. It may start as one lump and multiply like it invited friends. Early lumps can look like a pimple or boil, but HS bumps often feel deeper and more stubborn.

Real-life example: You try to treat it like a normal zit. It laughs at your acne patch.

5) Paired blackheads or clogged pores in a small pitted area

Some people notice clusters of blackheadssometimes in “pairs”in areas where HS tends to appear. On their own, blackheads aren’t proof of a flare, but if they show up in your usual HS zones alongside tenderness or itching, it can be part of the bigger pattern.

6) That tight “pulling” feelinglike your skin is tugging

HS can create inflammation that makes tissue feel tight, thick, or ropey. People sometimes describe a pulling sensation when moving (lifting an arm, walking, bending). If you’ve had HS for a while, this can also relate to scarring or early tunnel formation in more severe disease.

7) Dampness, drainage, or odor (even before a lesion fully opens)

Not every flare drains, but many do. Some people notice increased moisture or a faint odor before a bump breaks open. That’s not a judgment on youit’s a common feature of draining HS lesions. If you’re noticing this earlier than usual, it may signal a flare ramping up.

8) Movement suddenly hurts in a very specific way

A flare near a joint crease can make everyday movements feel weirdly painfullike your body is charging a toll for walking. Underarm lesions can make raising your arm miserable; groin or inner-thigh lesions can make walking feel like sandpaper negotiations.

9) Fatigue, headache, nausea, or feeling “flu-ish”

HS is inflammatory, and inflammation can affect the whole body. Some people report fatigue, headaches, mild feverish feelings, or nausea around flare time. These symptoms can have many causesso treat them as a clue, not a conclusion.

10) Hormone timing: flares that line up with your menstrual cycle

Many people who menstruate notice HS flares clustering before or around their period. If you keep seeing the same timinglike clockworkthis is a strong “flare forecast” clue and worth discussing with a clinician.

Common HS flare triggers (aka “things that make your skin file a complaint”)

HS triggers vary person to person. Some people can’t identify any triggers at all (which is rude, but real). Others have a short list that basically reads: “summer, stress, and tight jeans.” Here are common triggers many clinicians and studies discuss:

• Heat, sweating, and friction: Hot weather, workouts, long walks, and humid conditions can increase friction and moisturecommon flare ingredients.
• Stress: Physical or emotional stress can worsen inflammatory conditions. HS is not “in your head,” but stress can still crank up the body’s inflammation dial.
• Hormonal shifts: Menstrual cycle timing is a big one for many people. Some also report changes with postpartum periods or hormonal treatments.
• Smoking: Smoking is linked with worse HS outcomes and severity in many reports.
• Weight changes: Higher body weight can increase skin friction and inflammation. (This is not about blame; it’s about mechanics and biology.)
• Diet patterns: Some people report flares with high-sugar or high refined-carb patterns, or certain foods. The evidence isn’t one-size-fits-all, but tracking can help you learn your personal pattern.
• Skin irritation: Aggressive scrubbing, harsh fragranced products, shaving/waxing during sensitive periods, or irritating deodorants can trigger irritation for some people.

Your “10-minute flare forecast” checklist

If you’re trying to catch an HS flare early, this quick check can help you decide whether to go into gentle-care mode:

1. Do I feel itching/tingling/burning in my usual HS spots?
2. Is there a tender area that feels bruised or sore under the skin?
3. Is there warmth, swelling, or subtle discoloration starting?
4. Have I been sweating more, wearing tight clothing, or dealing with friction?
5. Am I unusually tired, headache-y, or feeling “off” for no clear reason?
6. Is this the time in my cycle when flares usually happen (if applicable)?

If you’re answering “yes” to a few, you don’t need to panicyou just might want to act early.

What to do when you notice early HS flare-up signs

Early action is about reducing friction, calming inflammation, and preventing skin barrier damage. Here are practical steps that are commonly recommended alongside your clinician’s plan.

Do this today: gentle, boring, effective

• Warm compress: Apply a warm (not scorching) compress for about 10 minutes to soothe pain and encourage drainage if a lesion is forming.
• Clean gently: Use a gentle, non-irritating cleanser. Avoid loofahs and harsh scrubbingHS does not respond well to being “power washed.”
• Consider an antiseptic wash if tolerated: Some clinicians recommend options like chlorhexidine or benzoyl peroxide washes for certain people. Patch-test your tolerance and follow medical advice.
• Reduce friction: Loose, breathable clothing. If you can, avoid tight waistbands, rough seams, or anything that rubs your tender spot like it’s trying to start a campfire.
• Hands off: Don’t squeeze, pop, or dig. It can worsen inflammation and scarring and raise infection risk.
• Pain plan: Over-the-counter pain relief may help some people (check with your clinician, especially if you have other health conditions).

Stick to your treatment plan (and don’t freestyle antibiotics)

If your clinician has prescribed topical treatments, oral medications, or biologics, consistency matters. HS often improves with long-term management rather than one-off fixes. If you’re having frequent flare-ups despite treatment, that’s a reason to check innot a reason to blame yourself.

When to get urgent medical help

Seek medical care quickly if you have any of the following:

• High fever, chills, or you feel seriously ill
• Rapidly spreading redness, severe swelling, or escalating pain
• A very large abscess, especially if it limits movement
• Signs of infection spreading (or if you have conditions that weaken immunity)

How to prevent HS flares (without living in bubble wrap)

Prevention isn’t perfection. HS can flare even when you do “everything right.” Still, many people reduce flare frequency with a few core strategies:

Lower friction and sweat where you can

• Choose breathable, moisture-wicking fabrics when you expect heat or movement.
• Take breaks on long walking days; change out of sweaty clothes sooner rather than later.
• If sweating is a major trigger, ask a clinician about antiperspirant options or other sweat management approaches.

Be strategic with hair removal

Shaving and waxing can irritate folliclesespecially during or right before a flare. Some people do better with careful trimming or exploring laser hair reduction under medical guidance.

Track patterns like a detective (but nicer)

Keep a simple flare journal: date, location, symptoms, cycle timing, stress level, heat/sweat exposure, clothing, and any dietary changes. You’re not trying to be perfectyou’re trying to spot trends so you can plan around them.

Support your whole-body health

Because HS is inflammatory, clinicians often discuss lifestyle factors like smoking cessation, weight management (if relevant), sleep, and stress reduction as supportive tools. None of these are “magic,” and none are moral judgmentsbut they can be part of a bigger, kinder strategy for your body.

FAQ: the questions everyone asks (usually at 2 a.m.)

Is HS contagious?

No. HS is not contagious. You can’t “catch” it from someone, and you can’t give it to someone. Secondary infections can happen in open wounds, but HS itself is not an infection you pass around.

Is HS caused by being “unclean”?

No. Hygiene doesn’t cause HS. Over-scrubbing can actually irritate skin and worsen symptoms for some people.

Is an HS flare just a boil?

HS can look like boils, but recurring lesions in typical areasplus scarring or tunnels over timeoften point toward HS rather than a one-off infected hair follicle. If you’re getting repeats, it’s worth an evaluation.

Experiences: what HS flare warning signs feel like in real life (about )

Medical descriptions are helpful, but they don’t always capture the lived experience of HSespecially the “uh-oh, it’s coming” feeling. Many people with HS describe early flare signals as less like a dramatic event and more like a slow, suspicious vibe. You’re not imagining it. Your body really can send subtle cues before the big bump arrives.

The “itch that has a GPS” is one of the most common stories. Not a normal itch. Not a mosquito bite itch. It’s the kind of itch that seems to live in one exact square inch of skinusually the same places you’ve flared before. Some people say it’s paired with tingling, like a tiny electrical buzz. Others call it burning, like their skin is lightly offended by oxygen.

Then comes the stealth tenderness. People often notice soreness before there’s anything to see. It can feel like a bruise forming under the surface, especially in the underarm or groin. One day you press the area and think, “Huh, that’s tender,” and the next day you’re walking like you’re trying to avoid setting off a motion detector.

Heat, sweat, and friction are frequent villains in the origin story. A long road trip in tight jeans. A workout followed by staying in damp clothes too long. A humid day where your skin folds basically become a microclimate. People commonly say the flare didn’t start because they exercisedmore like the combination of sweat + rubbing + heat created the perfect storm. (Your body: “I would like to file a complaint.”)

Menstrual-cycle timing can make the pattern painfully obvious for those who menstruate. Some people report flares that reliably show up right before their period, enough that they can predict it better than most weather apps. When that pattern is consistent, it’s worth bringing up with a clinician because hormonal strategies may be part of the broader management conversation.

The emotional “pre-flare spiral” is real, too. People describe a moment of dread when the familiar tingling startsbecause they know what might be next. If that’s you: you’re not dramatic. You’re experienced. A flare can affect sleep, movement, clothing choices, intimacy, and confidence. That’s a lot for a “skin issue.”

The most helpful shared lesson: treating early signs as a cue to go gentlenot to go to war with your skin. Warm compresses, reducing friction, skipping harsh scrubbing, and sticking to your treatment plan can feel “too simple,” but many people find those basics are what help them ride out the flare with less damage. If HS has taught anyone anything, it’s that force rarely wins. Strategy does.

Conclusion

HS flare-ups can feel random, but your body often drops hints: itching or tingling, bruise-like tenderness, warmth and swelling, deep pea-sized nodules, changes around your cycle, and sometimes whole-body fatigue. The earlier you notice your personal warning signs, the sooner you can shift into flare-friendly caregentle cleansing, warm compresses, less friction, and a check-in with your clinician when needed.

And if you take nothing else from this: HS is not your fault. Your job isn’t to be perfect. Your job is to be preparedand a little kinder to yourself on the rough-skin days.