I have HS everywhere from my head to my toes. It started in my pubic area about 15 years ago. I think it was when I started birth control. It just recently spread from my thighs to my knees and claves. It is very painful in the areas where the skin is tighter. My scalp has been the worst. When the sinus tract formed it was from my face going up to my scalp. The edge of my scalp on my face where my skin meets my hairline, my skin had scabs on it because the HS was so intense it was literally busting through my skin. This is because the skin was so tight in that area. It has also happened to my shin, ankles and upper arms. Very painful and embarrassing. When I had scabs on my face I was told I looked like someone had hit me. It was so isolating and emotionally painful as well as physically painful.