Updated 29 Oct 2026
At a glance
- To see whether a hidradenitis suppurativa (HS) treatment works, compare the same few measures before and after it starts: new lumps, drainage, pain, sleep, and photos.
- The NHS notes that a longer antibiotic course for HS will last at least 3 months, so a response is judged over weeks rather than days (NHS).
- The AAD advises telling your dermatologist if any wound fails to heal, opens up after healing, or becomes more painful (AAD).
- HS affects about 98 per 100,000 people in the US, with the highest rate among people aged 30 to 39 years (Garg et al., 2017).
- Hidradenitis Journey is a phone app (iPhone and Android) for tracking HS that keeps flares, medicines, photos, and side effects in one dated history.
Starting a new HS treatment brings a simple question that is surprisingly hard to answer: is it working? Breakouts come and go on their own, so a good week or a bad week can mislead you in either direction.
This guide explains how to track hidradenitis treatment response: setting a starting point, counting new lumps and drainage, scoring pain and sleep, logging doses and side effects, taking comparable photos, and bringing it all to a review.
How to set a starting point before hidradenitis treatment
The AAD notes that HS breakouts often clear for a while, and that new breakouts may later develop in the same area, sometimes in exactly the same spot (AAD). Because the condition comes and goes, a single week before or after a change says little on its own.
A starting point fixes that. Before a new treatment begins, or as soon as you know it is coming, log two weeks with the same measures you will use afterward: new lumps per week, draining areas, a daily pain score, nights broken by pain or itch, and a photo of each affected area.
If treatment has already started, write down what the previous month was like from memory and old photos, and mark it as an estimate. A rough baseline is far more useful than none.
Note the treatment start date clearly, with the name and dose. Every later comparison starts from that line.
In Hidradenitis Journey, the Daily check-in keeps the same guided fields every day, so the weeks before and after a treatment start can be compared directly. For a broader overview, see what to bring to a 15-minute visit.
How to count new lumps and drainage during hidradenitis treatment
The NHS describes HS as a painful, long-term skin condition that appears near hair follicles where there are sweat glands, usually around the groin, bottom, breasts, and armpits (NHS). Counting by area keeps the picture clear when several places are involved.
Once a week, on the same day, write the number of new lumps that appeared in each area, how many areas are draining, and whether any lump has stayed open longer than usual. Use the same area names every time.
Drainage is worth its own line. The AAD notes that when an abscess breaks open, blood and pus spill out (AAD). Record how many dressings you used in a day as a simple measure; fewer dressings over a month is a concrete sign of change.
| Weekly field | What to write |
|---|---|
| New lumps | Number per area: underarm, groin, buttocks, chest, thighs |
| Draining areas | Number, and dressings used per day |
| Slow-healing spots | Area and how long they have been open |
| Flare days | Days with a new painful lump |
Fields developed by Hidradenitis Journey.
In Hidradenitis Journey, the Flare Tracker marks each flare by date and area, so the weekly count before and after a treatment change is visible at a glance.
How to score pain and sleep during hidradenitis treatment
The AAD notes that pain and itch can affect your ability to fall asleep and stay asleep, and that some people say their skin burns, itches, or sweats excessively (AAD).
Rate pain 0 to 10 at the same time each evening, and add a separate itch score if itch bothers you. Note any night when pain or itch woke you, and how many hours you slept. These short lines can show change that lump counts miss.
Add a line on function: could you walk, sit, raise your arms, or work as usual? The AAD notes that some scars can limit movement and make walking difficult (AAD, signs and symptoms). A note such as "could sit through a meeting again" captures progress that numbers miss.
Keep pain medicine use on the same line, because using less of it is part of the response too.
In Hidradenitis Journey, the Daily check-in records pain, sleep, and mood beside each other, so a quieter week shows up in more than one field.
How to log doses and missed doses during hidradenitis treatment
The NHS describes several treatments for HS: a 1- or 2-week course of antibiotics, longer antibiotic courses of at least 3 months, antiseptic washes, treatments that suppress the immune system, and surgery when needed (NHS). Each has its own schedule, and a response can only be judged if the schedule was followed.
Record each medicine with the name, dose, start date, and every missed or delayed dose. For injections, note the date and site. For creams and washes, note how often you used them in practice, which may differ from the plan.
If a dose changes or a treatment is paused, write the date and the reason. A flare during a pause tells a different story from a flare on full dose.
The NHS also notes that if HS flares up before a period, oral contraceptives may help (NHS). If that applies, log cycle days beside flare days so the timing can be checked.
In Hidradenitis Journey, My Meds keeps doses and timings, and the Period Tracker keeps cycle days in the same history as flare days when timing matters.
How to track side effects during hidradenitis treatment
Side effects shape whether a treatment is worth continuing, so they belong in the same log as the benefits. Write each one on the day it happens, with a 0–10 severity and how long it lasted.
Keep the wording plain and consistent, such as "upset stomach after morning dose, 4/10, two hours". If a side effect stops you taking a dose, mark that too, because it links directly to the dose record.
Ask your clinician which side effects need a call and which can wait for the next review, and write the answer at the top of your log so it is easy to find.
Some changes are worth reporting promptly whatever the treatment. The AAD advises telling your dermatologist if you have joint pain, or if any wound fails to heal, opens up after healing, or becomes more painful (AAD). The NHS notes that some lumps may become infected with bacteria (NHS).
In Hidradenitis Journey, the Daily Journal holds side-effect notes on the day they happen, and My Labs keeps any blood test results that come with a treatment plan.
How to take comparable photos during hidradenitis treatment
Photos show change that words cannot, but only when they are taken the same way. Use the same room, the same light, the same distance, and the same angle each time. Photograph each affected area once a week on your count day.
The AAD notes that repeated healing and reopening may eventually cause scars and tunnels to form under the skin (AAD). Weekly photos help you and your dermatologist see whether areas are settling, staying open, or changing shape.
Label each photo with the date and area as you take it. Keep them private, and share only the ones needed for a review.
For scars and tunnels specifically, see what to photograph and log for scar and tunnel questions.
In Hidradenitis Journey, the Daily Journal keeps dated notes beside your photo dates, so each image has the week's counts and pain scores next to it.
How to log habits alongside hidradenitis treatment
Treatment rarely works alone. The AAD notes that sweating and overheating can cause a flare-up, that tight clothing can irritate the skin and make HS worse, and that dermatologists recommend people with HS never wax (AAD). The NHS notes that obesity and smoking are both strongly associated with HS (NHS).
If you change a habit during treatment, such as looser clothing, a different deodorant, or cutting down on smoking, log the date. Otherwise an improvement may be credited to the medicine when the habit change helped too, or the other way round.
The AAD notes that quitting smoking can also reduce HS flare-ups (AAD). If you are working on that, a daily count alongside flare days shows progress on both.
Hot weeks, exercise, and long days in tight work clothes are worth a short note as well, because they can explain a flare that has nothing to do with treatment.
In Hidradenitis Journey, Weekly Goals can hold one habit change at a time, and the Weight Tracker keeps weight readings if your plan includes them.
How to bring your treatment log to a hidradenitis review
The NHS notes that it is important to recognize and diagnose HS early to prevent it getting worse (NHS). Clear treatment reviews are part of that: they help decide whether to continue, change, or add a treatment.
Prepare one page: the treatment and start date, the baseline weeks, the latest four weeks of lump counts and draining areas, average pain and broken nights before and after, side effects, and missed doses. Bring three or four photos from the start and from the last week.
Put your main question first, such as "is this working well enough to continue?" and add one line on daily life: work, sleep, and movement.
If you are still waiting for a specialist, see what to track while waiting for the specialist.
In Hidradenitis Journey, the Doctor Report builds a dated summary of your recent progress for a saved doctor, and My Care Team keeps notes for each visit.
How Hidradenitis Journey can help
A notebook can hold flare dates. The harder part is comparing the weeks before a treatment with the weeks after it, while doses, side effects, habits, and photos all change at the same time.
Hidradenitis Journey is a personal HS tracker from Health Journey Labs on the App Store and Google Play. It records flares, pain, sleep, medicines, photos, and habits in one dated history, and its insights show which treatments and habits come before calmer or harder weeks. Learn explains the condition in plain words, and the AI companions, such as Clara, answer questions when a new symptom or result is hard to read. Below is what you can use and how each part helps:
- Daily check-in — A short guided pass across symptoms, mood, nutrition, sleep, exercise, meds, and external factors, including nodule pain, drainage, and skin-fold flares, so links you would not remember on your own show up side by side.
- Daily Journal — Freer notes, including voice when typing hurts, such as dressing counts, photo notes, and visit debriefs, that add detail a score alone cannot show.
- Flare Tracker — Mark a day clearly worse than your usual, with onset, sites, and intensity, so you can tell a one-off spike from a repeating pattern.
- My Meds — Medicine names and timing, so you can line up a start date or dose change with lump counts, pain, and sleep.
- My Labs — Result dates for swabs, blood work, imaging, and other tests, compared with how you felt in the weeks before and after.
- Weekly Goals — Set one small aim, such as a daily wash routine or looser clothing on long days, and see whether it held and whether flares changed.
- Learn — Short education topics on HS themes such as flares, sleep, pacing, and visit preparation.
- AI companions — Clara and specialist companions already see your logged history, which helps with visit wording or questions after a new diagnosis.
- My Care Team — A profile for each clinician, plus upcoming appointments and notes for each visit, used before, during, and after appointments.
- Doctor Report — Two views: the Appointment Planning Report helps you prepare what to ask, and Generate Report, opened from a saved doctor, builds a dated summary of your recent progress for that doctor.
- My Assessments — Structured check-ins that add context about you across weeks.
- Food Tracker — Meal and drink lines when food is something you and your clinician are watching alongside flares.
- Period Tracker — Cycle dates, so you can see whether new lumps cluster at a certain point in the cycle.
- Weight Tracker — Weight entries when weight is part of what you and your clinician are watching.
Everything you log builds one history. Guided forms include the key questions, and you can add custom symptoms when you need your own labels. Hidradenitis Journey is free to download.
We make Hidradenitis Journey at Health Journey Labs. This guide is educational and does not replace care from your clinicians; for diagnosis and treatment decisions, work with your treating clinicians.
Sources
- NHS — Hidradenitis suppurativa (HS)
- American Academy of Dermatology (AAD) — Hidradenitis suppurativa: Signs and symptoms
- American Academy of Dermatology (AAD) — Hidradenitis suppurativa: Self-care
- Garg A, et al. Sex- and Age-Adjusted Population Analysis of Prevalence Estimates for Hidradenitis Suppurativa in the United States. JAMA Dermatol. 2017
FAQ
How do I know if my hidradenitis treatment is working?
Compare the same measures before and after the start date: new lumps per week, draining areas, dressings used, daily pain, and broken nights. Look at four-week blocks rather than single weeks, because HS breakouts come and go on their own. Dated photos add a visual check.
In Hidradenitis Journey, the Daily check-in and Flare Tracker keep those measures in the same format every week. After a month or two you can see whether the post-treatment weeks look different.
How long before hidradenitis treatment shows a response?
It depends on the treatment, so ask your clinician what timeline to expect and write it at the top of your log. The NHS notes that a longer antibiotic course for HS lasts at least 3 months, which is a reminder to judge response over weeks rather than days.
With Hidradenitis Journey, My Meds marks the start date, and the weeks that follow build up in the same history, so the review date arrives with a full record rather than a guess.
What should I log before starting a new HS treatment?
Log two weeks of the same measures you will track afterward: new lumps per area, draining areas, dressings per day, a daily pain score, broken nights, and a weekly photo of each area. If treatment has already started, write an estimate of the previous month.
In Hidradenitis Journey, the Daily check-in holds those fields from day one, so the baseline and the treatment weeks share one history and compare directly.
How do I track side effects of hidradenitis treatment?
Write each side effect on the day it happens with a 0–10 severity and duration, using the same words each time. Mark any dose you skipped because of it. Ask your clinician which side effects need a call and keep that answer at the top of your log.
In Hidradenitis Journey, the Daily Journal holds side-effect notes beside the day's symptoms, and My Meds shows the doses they followed, so both arrive together at the review.
How should I photograph hidradenitis to track treatment?
Use the same room, light, distance, and angle each week, on the same day you count lumps. Label each photo with the date and area as you take it. Bring a few photos from the start and the latest week to each review.
With Hidradenitis Journey, the Daily Journal keeps dated notes for the same weeks as your photos, so each image is read together with that week's counts and pain scores.
Do habits affect hidradenitis treatment results?
They can. The AAD notes that sweating, overheating, and tight clothing can worsen HS, and that quitting smoking can reduce flare-ups. Log the date of any habit change during treatment so improvements are credited correctly, whether to the medicine, the habit, or both.
In Hidradenitis Journey, Weekly Goals holds one habit change at a time, and the weekly view shows how flare counts moved alongside it during the same treatment period.
When should I contact my dermatologist during HS treatment?
The AAD advises telling your dermatologist if any wound fails to heal, opens up after healing, or becomes more painful, and if you have joint pain. Ask your clinician at the start which side effects need a call, and write that list down.
In Hidradenitis Journey, the Daily Journal records when each change started, and My Care Team keeps your dermatologist's details and notes, so the call starts with dates rather than memory.
What should I bring to a hidradenitis treatment review?
Bring one page: the treatment and start date, baseline weeks, the latest four weeks of counts, pain and sleep before and after, side effects, missed doses, and three or four photos. Put your main question first, such as whether to continue.
In Hidradenitis Journey, the Doctor Report builds a dated summary from what you logged, and My Care Team keeps notes from each review for the next one.
What if my hidradenitis gets worse after starting treatment?
Log it the same day with counts, pain, and photos, and contact your clinician if a wound fails to heal, opens up after healing, or becomes more painful, as the AAD advises. Note any missed doses or habit changes that week, since they help explain the change.
In Hidradenitis Journey, the Flare Tracker marks the worse days by date and area, and My Meds shows the doses around them, so your clinician can see the full sequence before deciding on a change.
Does privacy matter for a hidradenitis log?
Yes. An HS log can hold photos of intimate areas, medicines, and work days missed, so treat it as private. On paper, keep the notebook and printed photos somewhere only you control, and share them only when you choose.
The app's own security screen lists Hidradenitis Journey as HIPAA-ready and GDPR compliant, with AES-256 encryption for your data. You choose what to share with partners or clinicians.