ESA for Hidradenitis Suppurativa: How to Describe Your Limitations on the WCA

Updated May 2026 - Based on current WCA descriptor framework

Hidradenitis suppurativa (HS) causes painful, recurring abscesses and boils in the armpits, groin, buttocks, and under the breasts. Severe HS causes chronic pain, scarring, wound drainage, and significant limitations on sitting, standing, and movement. Other chronic inflammatory skin conditions are assessed on the same functional basis, and our guide to ESA for eczema and psoriasis covers how flares and skin pain map to the WCA activities.

The Work Capability Assessment does not ask "do you have hidradenitis suppurativa?" It asks how your condition affects your ability to perform 17 specific work-related activities. You need 15 points across all activities for Limited Capability for Work (LCW), or you must meet a Support Group (LCWRA) descriptor.

Which WCA Activities Does Hidradenitis Suppurativa Affect?

• Standing and sitting - Directly affected by hidradenitis suppurativa
• Mobilising - Directly affected by hidradenitis suppurativa
• Reaching - Directly affected by hidradenitis suppurativa
• Manual dexterity - Directly affected by hidradenitis suppurativa
• Continence - Directly affected by hidradenitis suppurativa
• Social engagement - Directly affected by hidradenitis suppurativa
• Personal action - Directly affected by hidradenitis suppurativa

Points from all 17 activities are combined. Even moderate scores across several activities can reach the 15-point threshold.

HS and Sitting/Standing

HS lesions in the groin and buttocks make sitting extremely painful. Lesions in the armpits make arm movement painful. This directly affects Activity 2 (Standing and sitting) and Activity 3 (Reaching). Describe the locations of your lesions and how they specifically limit your ability to remain at a work station: "Active HS lesions in my groin and buttocks mean I cannot sit in any chair without severe pain. The lesions are open and draining, requiring frequent dressing changes throughout the day."

Wound Management

Active HS requires wound dressing, pain management, and hygiene care multiple times per day. This takes significant time and is difficult to manage in a workplace setting. The drainage from lesions can soak through clothing, causing embarrassment and hygiene concerns that affect social engagement (Activity 16).

How to Describe Hidradenitis Suppurativa on Your ESA50/UC50 Form

The biggest mistake claimants make is describing their condition in medical terms rather than work-related terms. The WCA does not care about your diagnosis - it cares about what you cannot do reliably, repeatedly, and safely in a workplace context over an 8-hour working day, 5 days a week.

For each activity, describe your worst typical day (not your best), explain how often limitations occur, mention medication side effects, and always frame your answer in terms of workplace capability.

Evidence to Support Your Claim

• GP or specialist letters confirming diagnosis and work impact
• Prescription records showing medication and side effects
• Fit notes or med3 certificates
• Hospital or clinic appointment records
• A personal diary showing day-to-day variation

Support Group for Hidradenitis Suppurativa

You may qualify for the Support Group if your condition means that work-related activity would pose a substantial risk to your health. Ask your GP to write a letter specifically stating: "Requiring [your name] to engage in work-related activity would pose a substantial risk to their health." This mirrors the legal test and carries significant weight with decision makers.

A Worked Example: How an HS Flare Maps to WCA Points

The way to win points is to translate each symptom into the specific activity and descriptor the assessor scores. Here is how a typical severe flare can map across several activities.

Standing and sitting: lesions in the groin, buttocks and inner thighs make sitting in a normal chair acutely painful. The descriptors on this activity look at how long you can remain at a work station - whether seated, standing, or a combination - before the pain forces you to move. If active lesions mean you cannot stay seated or stand for even a short period without having to move because of severe pain, that is a scoring difficulty, not a minor inconvenience.

Mobilising (moving around): lesions in the groin and thighs can make walking painful and slow, reducing the distance you can cover before needing to stop. The shorter your reliable walking distance, the higher the score on this activity.

Reaching: lesions in the armpits make raising the arms painful, so reaching to shoulder or head height - for example to a shelf or to put something in a top pocket - may not be possible during a flare. This is a separate activity from standing and sitting, and the points add together.

Manual dexterity: where lesions affect the hands or where pain and dressings limit grip and fine movement, difficulty using a pen, keyboard or everyday controls can score here.

Continence: where lesions, drainage or surgery near the perineum affect bowel or bladder control, or where management requires frequent unplanned trips, the continence activity may apply.

The Reliability Test and "Good Days and Bad Days"

HS flares and settles, which makes it a fluctuating condition - and how fluctuation is handled is the heart of the claim. The assessor must decide whether you can do each activity reliably, repeatedly, safely, in a reasonable time, and for the majority of the time, which means more than half the time. If a flare stops you sitting, walking or reaching on most days, the law treats you as unable to do that activity, even though you can manage it between flares.

The word "safely" deserves attention with HS. Working with open, draining wounds carries a genuine risk of infection, and an activity that could lead to a wound becoming infected is not one you can do safely. The word "repeatedly" matters too: you might sit through one short task, but if the pain builds so that you cannot repeat it through a working day, you cannot do it repeatedly. And "reasonable time" applies if pain slows everything you do to a crawl.

Spell out frequency. If you flare for, say, two weeks in every month and during a flare you cannot sit, walk or reach reliably, then for the majority of any month you are unable to do those activities. Counting it out like this makes the "majority of the time" test obvious instead of leaving the assessor to guess.

Wound Care, Dressings and the Working Day

One of the most under-described parts of an HS claim is the sheer time and disruption of wound management. Active lesions need cleaning, dressing and pain management, often several times a day, and drainage can soak through dressings and clothing without warning. In a workplace this is not a quick toilet break: it requires privacy, clean conditions, fresh dressings and time. Explain how many times a day you must attend to wounds, how long it takes, and why an ordinary work environment cannot accommodate it reliably.

This feeds several activities at once. The interruptions affect whether you can remain at a work station (standing and sitting). The risk of leakage and odour, and the embarrassment it causes, can affect social engagement if it leads you to avoid contact with others. And the unpredictability of drainage links directly to the reliability and safety tests above.

Common Mistakes Claimants With HS Make

• Underplaying the pain. HS pain is severe and is frequently underestimated. Describe it honestly and in terms of what it stops you doing, not on a vague scale.
• Describing a good week. The form asks what you cannot do reliably. Anchor every answer to a typical flare and how often flares occur.
• Skipping the wound-care burden. The time, mess and infection risk of dressing changes is central to why work is not reliable - do not leave it out.
• Ignoring the mental-health impact. Chronic pain, scarring, odour anxiety and isolation commonly cause depression and anxiety. These can score under the mental-function activities, and mental and physical points are added together.
• Forgetting medication side effects. Strong painkillers, antibiotics and biologic treatments carry side effects and clinic appointments that affect reliability. Side effects that limit your function count.
• Not keeping a diary. A dated record of when you flare, where the lesions are and how they affect sitting, walking and reaching turns "frequently" into evidence.

Evidence: What to Gather and Who to Ask

The diagnosis is rarely the issue with HS; the assessor needs to understand severity, frequency and functional impact. Aim to assemble:

• A dermatology letter that goes beyond the diagnosis - ideally stating the Hurley stage, the sites affected, how often you flare, and how this limits sitting, walking, reaching and wound management at work.
• A GP letter linking symptoms to specific work-related limitations and, where appropriate, stating that requiring you to undertake work-related activity would pose a substantial risk to your health, for example through wound infection.
• Records of surgery and wound care: incision and drainage procedures, wide excisions, district nurse involvement or any ongoing wound-care plan.
• A symptom diary over several weeks recording flare dates, lesion sites, pain levels and how each flare affected sitting, walking and reaching. This directly answers the "majority of the time" question.
• A medication list including any biologic treatment, antibiotics or strong analgesia, with the side effects that limit you.

When you ask for a letter, give the clinician the functional language to use. "Mr X has hidradenitis suppurativa" helps far less than "Mr X has Hurley stage III HS with active draining lesions in the groin and axillae; during frequent flares he cannot sit or walk without severe pain and requires dressing changes several times a day."

The Substantial-Risk Route to the Support Group

For HS, the substantial-risk rule is often the clearest route into the Support Group (LCWRA in Universal Credit). Under Regulation 35 (ESA) and Regulation 40 (Universal Credit), if requiring you to take part in work-related activity would pose a substantial risk to your physical or mental health, you should be treated as having limited capability for work-related activity even without meeting a Schedule 3 descriptor on points alone.

With HS the physical risk is real and easy to evidence: open, draining wounds in a workplace carry a genuine infection risk, and being pushed into activity during a flare can worsen lesions and delay healing. There is often a mental-health dimension too. Ask your GP to put it in writing using the legal wording: "Requiring [name] to engage in work-related activity would pose a substantial risk to their health because of the risk of wound infection and the impact on their physical and mental health." The other two routes to the Support Group - scoring 15 points on a single activity, or meeting a Schedule 3 descriptor - remain open, and you only need one of the three to succeed.

The Consultation and Challenging a Refusal

The assessment is now usually a telephone or paper-based consultation, so the assessor will not see your lesions. That makes your description do all the work. Walk through a typical bad day: where the lesions are, how they feel, why you cannot sit or stand for long, how often you change dressings, and what happens when drainage leaks. If pain or embarrassment makes the phone call itself difficult, you can say so, and you can ask for reasonable adjustments.

If the decision is wrong - too few points, or placed in the Work-Related Activity Group rather than the Support Group - challenge it with a Mandatory Reconsideration first, then an appeal to the independent First-tier Tribunal if needed. HS claims are easily underscored because the condition is hidden, fluctuating and poorly understood, and a paper or phone assessment can miss its severity. Use the reconsideration to add your symptom diary and a severity-focused clinician letter, and read the decision letter carefully: it shows the points awarded for each activity, which tells you exactly where to focus your challenge.

How much could your ESA be worth?

The amount depends on whether you reach the 15-point threshold for Limited Capability for Work, and whether you qualify for the Support Group (LCWRA). As a rough starting point, enter your main condition below to see the kind of figure a successful claim can reach. It is only an estimate - your real award depends on how the Work Capability Assessment scores your difficulties across the 17 activities.

For the official figures, see our free WCA points calculator and what ESA is and how much it pays.

Official sources

This guide reflects the official Work Capability Assessment rules. For the source material, see:

• GOV.UK - Employment and Support Allowance
• GOV.UK - Health conditions, disability and Universal Credit
• The Employment and Support Allowance Regulations 2013 (Schedule 2 - WCA descriptors)
• Citizens Advice - Employment and Support Allowance

Guidance only, not legal advice. Rules can change - always check GOV.UK for the latest.

Frequently Asked Questions

What if You Are Rejected?

Around 2 in 3 ESA mandatory reconsiderations result in a changed decision. If you are scored too low, challenge the decision - the odds are in your favour. Read our mandatory reconsideration guide for step-by-step instructions.

Related Guides

• Complete WCA guide
• How to fill in the ESA50 form
• WCA descriptors explained
• What to say at your WCA assessment
• How to qualify for the Support Group