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For some people, a Hidradenitis Suppurativa flare-up is sudden. But for others, there are signs. In medicine, these signs are called a prodrome.

A prodrome is a set of signs and symptoms a person experience before a flare-up. It is often associated with migraine or epilepsy but occurs in many diseases. A 2017 survey of 72 HS patients found 83% had symptoms before a flare. Another 2014 study found 50% of patients reported prodromal signs 12-48 hours before a lesion was visible.

So, we know that a significant amount of people has some indication of an oncoming flare. You may not have noticed before if you have other conditions as well as HS. But knowing ahead of time can help you be prepared. Here are some of the most common signs.


Fatigue is a common complaint of people living with HS. It affects so many people with HS during but also before a flare-up. The 2017 study found that 32% of patients experienced fatigue before a flare-up. Some experts have suggested that inflammation zaps your energy. Your body uses available energy to fight inflammation, making you feel tired. This may explain why you feel fatigued because your body tries to fight the flare-up.

hidradenitis suppurativa fatigue

Pain and Soreness

For some people, a flare can start with soreness. You can feel pain on its own or accompanied by a lump. For some people, it’s tenderness and a sting for others. However it presents itself, pain and soreness may well be your first signs of a flare-up. 74% of those studied said they experienced erythema. Erythema is a raised, sore patch of skin caused by inflamed blood capillaries. This might explain why a HS fare begins with soreness for some people. Erythema is associated with infection and, in some cases, a reaction to a drug. So, if you experience this sign, check in with your doctor. They might just be able to help with this one.


11% of those studied said they experienced headaches before a flare-up. Headaches accompanied by a temperature can indicate an infection. They are also associated with inflammation. Both of which are common symptoms of HS.

hidradenitis suppurativa headaches

Itching and Tingling

In that 2017 study, 20% of patients were found to have itching before a flare-up. Itching can occur anywhere you might get a lesion. Areas include the underarms, thighs but most common are the buttocks.

Paraesthesia is the medical term for tingling, prickling or numbness caused by pressure on nerves. 63% of patients were found to have paraesthesia before a flare-up.


You may or may not call this one a sign, but your period is a predictor. Many women report HS flare-ups before their period. So, if you know your period is due, be aware you may also have a flare-up on the way.  Doctors believe hormones are a key part of understanding HS. However, they don’t yet understand the link. HS is more common in women with many first symptoms in puberty. And as well as premenstrual flares, HS symptoms often change during pregnancy. If you have flare-ups during your period, you are not alone. So, just like making sure you have enough pads, make sure your HS kit is stocked each month too.

hidradenitis suppurativa periods

To each their own

As always, I would like to note that everyone experiences HS differently. You may not experience any of these pre-flare symptoms. Or you may find you have had them all. A second prospect is an interplay between HS and other conditions. We know that HS carries a risk of other conditions like diabetes, heart disease and more.  Many of these symptoms, like fatigue and headaches, are non-specific. If these are persistent and causing you difficulty, see your doctor.  Not only can your doctor offer advice and treatment, but they can also rule out other causes. Your prodrome might be telling you more than you think. So, always get checked out!