Hidradenitis suppurativa, or HS, is a chronic skin condition that frequently gets mistaken for other, more familiar skin problems. The condition appears as boil-like lumps in areas where skin rubs together and sweats, such as the armpits and groin.
Knowing which conditions HS is most often confused with can help patients push for a proper evaluation.
Why Acne and HS Are Not the Same Problem
Acne vulgaris is far more common than HS, affecting more than 9% of people worldwide. HS affects up to 4% of the population. Because acne is so widespread, doctors may default to that diagnosis when they see bumps on the skin.
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Acne typically shows up as papules, pustules, or nodules on the face, though it can also appear on the back, chest, arms, and buttocks. It happens when sebaceous glands become overly sensitive to androgens like testosterone. HS, by contrast, develops when hair follicles become blocked, though researchers are still working to understand exactly why those blockages occur. The lumps of HS tend to show up in sweat- and friction-prone zones rather than on the face.
Another form of acne, acne conglobata, is a rare and severe type of nodulocystic acne. It features cysts and nodules that connect under the skin, which can lead to infections and scarring. That tunneling effect makes it look similar to HS, and the two conditions can coexist in the same person. One distinguishing factor is that HS often appears in areas subjected to friction from skin-on-skin contact or chafing, while acne conglobata can appear anywhere on the body.
When Lumps Look Like Cysts, Ingrown Hairs, or Folliculitis
A cyst is a fluid-filled sac that can result from injuries or minor infections. Many cysts go away on their own, though some need treatment. HS bumps can resemble cysts, but HS is an ongoing inflammatory condition rather than a one-off sac.
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Ingrown hairs also cause confusion. After shaving, waxing, or tweezing, a hair can curl inward and create a bump commonly called a razor bump. Since HS often develops in areas where people routinely remove hair, like the armpits and bikini line, the two can look alike. Both involve blocked follicles, but the cause of the blockage in HS is more complicated than a single trapped hair.
Folliculitis, an inflammation of hair follicles usually caused by bacterial infection, produces small bumps that can resemble ingrown hairs or HS. Mild cases of folliculitis often clear up with at-home care, while more severe forms may need antibiotics. HS, on the other hand, is a chronic condition.
Boils Are Often Confused With HS
A boil, or furuncle, is a bump filled with pus. The bump develops from a bacterial infection, often of a hair follicle. The infection causes a buildup of immune and skin cells, which leads to the formation of the bump. A carbuncle is a cluster of boils. People often confuse HS with boils. However, boils are the result of an infection, and proper treatment
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