Pain was identified by patients as the most defining flare symptom of hidradenitis suppurativa (HS), according to data from a study published in the British Journal of Dermatology.

As a comprehensive definition for flare has not yet been established and flare symptoms have not yet been quantitatively explored, researchers sought to characterize the physical symptoms of HS flares from patients’ perspectives. Data from 438 participants (93.8% women) in an anonymous survey posted on HS Facebook groups by group administrators from February through March, 2020 were analyzed. The mean age of participants was 37.6±10.7 years. Participants were asked to self-report Hurley stage, select symptoms from a list that they believed characterized HS flare, and to indicate their most defining HS flare symptom.

Pain was the most commonly reported flare symptom (98.9%), followed by drainage (91.8%), itchiness (81.1%), bleeding (78.8%), and an increased number of new lesions (66.7%). Nearly half of respondents (47.7%) reported experiencing all 5 symptoms during flares. Pain was most frequently reported as the most defining feature of flare (78.8%), followed by drainage (12.8%). There was no significant association between Hurley stage and the most defining flare symptom or likelihood of experiencing pain or itching during flares. Drainage was significantly more common during flares in Hurley III than Hurley I (P <.0002) and in II than I (P =.0004). New lesion flares were significantly more common in Hurley III than II (P =.0043) or I (P <.0002) and in II than I (P =.0005). Bleeding was significantly more common during flares in Hurley III than II (P =.0141) or I (P <.0002) and in II than I (P =.0206).

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Limitations to this study include the lack of race, gender, and Hurley stage diversity. Facebook HS groups may not be representative of the general population.

The results of this study suggested that pain is the most defining symptom of HS flare and that new lesions are not the most defining flare symptom for most HS patients, despite the use of new lesion count as defining flares in clinical trials. The investigators believe that lesion count alone may not comprehensively characterize a flare, especially for Hurley I patients. Flare symptoms varied by disease severity, indicating flare severity may be a more useful outcome measure than flare frequency, they noted.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Fernandez JM, Thompson AM, Kirby JS, Hsiao JL, Shi VY. Characterizing physical symptoms of flare in hidradenitis suppurativa: A patient survey. [published online July 23, 2020]. Br J Dermatol. doi:10.1111/bjd.19412