Acne Inversa: Same as HS? Names, Meaning and Complications

Yes: acne inversa and hidradenitis suppurativa (HS) are two names for exactly the same condition, a chronic inflammatory skin disease that causes deep, painful lumps, abscesses and scarring in areas where skin rubs against skin. If a doctor, a leaflet or a website mentions acne inversa, they are talking about HS, and the other way around. I have lived with this condition for most of my adult life, and I remember how confusing the naming was at the beginning. So in this article I want to untangle it properly: where both names come from, why neither of them describes the disease very well, how acne inversa actually presents, and which complications are worth knowing about, not to scare you, but because they are the strongest argument for taking the condition seriously early.

Why is it called acne inversa?

The name was proposed by the dermatologists Plewig and Steger in 1989, and the logic behind it is described in a review by Jansen and Plewig in the Journal of the European Academy of Dermatology and Venereology. Under the microscope, the disease starts the way acne starts, with a blocked hair follicle. But the location is the opposite, or "inverse", of ordinary acne: instead of the face, chest and back, it affects the armpits, groin, buttocks and the skin under the breasts. Hence acne inversa, the acne of the inverse areas.

The name has one big problem: this disease is not acne. It behaves differently, it scars differently, and it usually does not respond to acne treatments. I learned that the hard way. Years ago I took isotretinoin, the active ingredient once sold as Accutane, for ordinary acne on my back. It cleared the acne completely. My HS did not improve at all, and while I was on the drug it actually got worse, an experience I later found echoed by many other patients in the community. If you have ever been handed an acne product for deep, painful lumps in your armpits or groin and wondered why it did nothing, this is why.

Is "hidradenitis suppurativa" more accurate?

Not really. The official name is a Latin description that translates roughly as "inflamed sweat glands that leak pus", and it reflects what doctors believed when the disease was first described: that it was primarily a disease of the apocrine sweat glands. Current research tells a different story. A review by Wollina and colleagues describes follicular occlusion, a blockage of the hair follicle unit, as the crucial first step, with the sweat glands involved secondarily. In other words, the sweat glands are bystanders that get caught up in the inflammation, not the cause.

The same review lists the other names this condition has collected over the centuries: Verneuil's disease, after the French surgeon who studied it in the 1850s, and even "smoker's boils", a nickname that reflects how strongly smoking is associated with it. Four names, and not one of them describes the disease well. What matters in practice is simpler: whichever name appears on your medical records or in an article you are reading, it is the same condition, with the same behaviour and the same care options.

Why do the two names matter in real life?

Because the confusion around this disease has a measurable cost. A 2024 paper in Skin Appendage Disorders reports a mean delay of about ten years between first symptoms and a correct diagnosis in the authors' cohort, in line with earlier international studies reporting seven to ten years, with no real improvement over time. Cleveland Clinic notes that healthcare providers often mistake HS lesions for simple infected boils, which is one of the reasons the condition slips through so many appointments unrecognised.

My own diagnosis took about a year of going from one doctor to another, and I consider myself lucky compared to those averages. The first verdict I received, at a hospital near Milan, was blunt: a chronic condition I would deal with for the rest of my life. What I did not receive for a long time was the name. Only later did a dermatologist finally say "hidradenitis suppurativa" out loud, and having a name changed everything, because a name is what lets you search, read, find other patients and ask better questions. That is exactly why knowing both names matters: depending on the country and the doctor, you may hear either one, and recognising them as the same disease saves you from starting your research twice.

How does acne inversa present?

The typical picture, described in detail by DermNet, is persistent, deep-seated, painful nodules and abscesses in apocrine gland-bearing skin: the armpits, the groin, the perianal region, the buttocks and the folds under the breasts. Over time, lesions can progress to tunnels under the skin, called sinus tracts, along with drainage and scarring. The disease usually appears after puberty. Prevalence estimates in the review by Wollina and colleagues range from under 1 percent to about 4 percent depending on the region, and Mayo Clinic notes that women are about three times more likely to develop it, and that Black people are affected more often than other groups.

Two things the presentation is not, according to Cleveland Clinic: it is not contagious, and it is not a hygiene problem. The lumps can appear in intimate places and can be mistaken for sexually transmitted infections, which adds a layer of shame that the disease does not deserve. Nobody gave it to us, and we cannot give it to anyone.

Severity is usually described with the Hurley stages, from occasional isolated nodules in stage I to interconnected tracts and widespread scarring in stage III. I have written a detailed guide to the Hurley stages, and one point from it is worth repeating here: acne inversa does not follow a guaranteed pattern of progression. Being diagnosed at one stage is a description of your skin at that moment, not a prediction of your future.

What are the complications of acne inversa?

This is the part of the disease that the "acne" in the name hides most unfairly, and it is also the strongest reason to seek care early rather than push through alone. The complications described in the literature are mostly tied to long-standing, uncontrolled inflammation, so I want to frame this list the way I wish someone had framed it for me: not as a forecast, but as what doctors watch for, and what early diagnosis and treatment aim to prevent.

Scarring and restricted movement. Mayo Clinic describes rope-like scars and pitted skin, and notes that scar tissue can limit movement, especially where the disease affects the armpits or thighs. This one I know personally: years of abscesses left me with many raised, hypertrophic scars, and learning how to care for them became its own chapter of my journey.
Secondary infection. An affected area can pick up a true bacterial infection, although Mayo Clinic points out that pus alone is common in HS and does not automatically mean infection.
Swelling from lymphatic damage. The most affected areas are rich in lymph nodes, and scar tissue can interfere with lymph drainage, which can cause swelling in the arms, legs or genitals, a complication called lymphoedema, reported by both Mayo Clinic and DermNet.
Fistulas. In severe long-standing disease, the review by Wollina and colleagues describes abnormal channels, called fistulae, that can form between the skin and structures such as the rectum, urethra or bladder.
Anaemia and systemic effects. Chronic inflammation can affect the whole body, and both DermNet and the Wollina review list anaemia of chronic disease among the possible systemic complications.
Skin cancer, rarely. Mayo Clinic reports that squamous cell carcinoma has been described in long-standing HS, particularly involving the perianal area. It is rare, and it is one more reason why long-neglected disease deserves medical follow-up rather than resignation.
The weight on your mind. Pain, drainage, odour and the location of the lesions can push people into isolation, anxiety and depression, which Mayo Clinic lists among the complications and DermNet describes as psychosocial morbidity. In my experience this side is at least as heavy as the physical one, and it deserves the same attention and the same care.

Separate from complications, DermNet also notes that HS travels with certain comorbidities, conditions that are more common in people with the disease, including metabolic syndrome and psychiatric disorders. That is another argument for having a doctor who follows you over time, rather than treating each flare as an isolated emergency.

If something in this list worries you right now, escalating pain, spreading redness, fever, swelling that does not settle, or a wound that will not close, that is a reason for a prompt medical appointment, not for more waiting.

Living with the disease behind the names

Whatever you call it, this condition has no definitive cure today. That sentence is hard to read, I know, but pretending otherwise would be dishonest, and it is also not the end of the story. Inflammation can be managed, flares can become rarer and milder, and many of us reach long quiet periods. Dermatologists have a growing toolbox, from medical therapy to surgical options, and I have summarised what the evidence says about it in my overview of what hidradenitis suppurativa is.

In my case, the biggest turning point was food related: an elimination and reintroduction approach in the AIP style, which helped me reach remission of my symptoms. Remission for me, not a cure, and my results are my own, not a promise. The complete story, including the many things that did not work first, is in my book. I am a patient, not a doctor, so treat everything here as experience plus published evidence, and talk to your dermatologist about what fits your case.

FAQ

Is acne inversa the same as hidradenitis suppurativa? Yes, they are two names for the same chronic inflammatory skin disease. Acne inversa is the name proposed by Plewig and Steger in 1989; hidradenitis suppurativa is the older, official name. Verneuil's disease is a third, historical synonym.

Is acne inversa contagious? No. Cleveland Clinic is explicit that HS is not contagious and is not a sexually transmitted infection. It is an inflammatory condition of the hair follicles, not an infection you can pass on.

Is acne inversa caused by poor hygiene? No. Cleveland Clinic states clearly that HS is not a consequence of poor hygiene. Washing more, or more aggressively, does not prevent the disease and can irritate already inflamed skin.

Is acne inversa just severe acne? No. The two conditions share a starting point, a blocked hair follicle, but acne inversa is a distinct disease with different locations, deeper lesions, tunnels and scarring, and it typically does not respond to standard acne treatments.

Does acne inversa always get worse over time? No. There is no guaranteed pattern of progression: some people remain at a mild stage for life, others improve, others worsen. Established scars and tunnels can persist, which is why early care matters, but a diagnosis is not a countdown.

Acne Inversa: Is It the Same as Hidradenitis Suppurativa?