There are so many conditions that can look the same, sometimes causing confusion about your diagnosis. One of the most commonly confused conditions with hidradenitis suppurativa (HS) is folliculitis. While they may look similar at first, knowing their differences is important to getting the right diagnosis and care.
What is hidradenitis suppurativa?
HS is a chronic inflammatory skin condition that causes painful, boil-like abscesses which can develop anywhere on the body with hair follicles. However, it most commonly appears in areas such as the armpits, groin, buttocks, inner thighs and under breasts. Over time, HS can develop tunnels under the skin called sinus tracts, and scarring develops.
What is folliculitis?
Folliculitis is a temporary infection of the hair follicles caused by bacteria or fungus. It typically appears as small, red, inflamed spots that may feel itchy, slightly painful, or have no symptoms at all. Folliculitis often resolves on its own or with simple treatments.
Why is it important to differentiate between HS and other conditions?
Early HS can often be mistaken for folliculitis or simple boils and causes delays in treatment Many people with HS don't seek help from a dermatologist until their HS has progressed to a more severe stage. Early diagnosis is key to managing HS, limiting tissue damage and reducing its impact on your skin and life.
Some key characteristics to keep in mind:
Folliculitis typically resolves in a short time with treatment or on their own.
HS tends to cause recurring lesions in the same areas over time. If you notice that your skin issues keep coming back, it’s more likely to be HS than folliculitis.
Folliculitis rarely leads to scarring, tunnels, or the large abscesses seen in HS. If you notice your skin issues are changing for the worse, talk to your provider about the possibility of HS.
What can you do to help get a diagnosis?
HS is diagnosed by a healthcare provider based on your symptoms and medical history. In HS, diagnosis is made based on three criteria:
Chronicity: Has the disease lasted for more than six months?
Recurrence: do your skin issues come back in the same areas? Do the same boil-like abscess drain and fill repeatedly?
Lesion characteristics: Do you experience painful bumps, boil-like abscesses, sinus tracts or scarring?
It’s suggested that you keep a detailed record of your symptoms, including where the lumps are on your body, what they look like and how they feel, how often they come back, and any treatments you’ve tried. One option for tracking is the Papaya app for both iOS and Google Play.
Don’t be afraid to speak up when seeing your care provider – you know your body best! Explain that your symptoms are chronic and recurring. You might say something like, "I’ve been dealing with these boil-like abscesses for several months, and they keep coming back. I’m concerned that it’s HS."
If you’ve been diagnosed with HS, please know that there are many emerging treatments and the future is bright. Having HS does not mean that you cannot live a full life, and HS Connect is here to support you every step of the way. Use our resources to find an HS-knowledgeable physician near you, or join us at an upcoming event. We would love to connect with you!
References
Winters RD, Mitchell M. Folliculitis. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547754/
Sabat, R., Jemec, G.B.E., Matusiak, Ł. et al. Hidradenitis suppurativa. Nat Rev Dis Primers 6, 18 (2020). https://doi.org/10.1038/s41572-020-0149-1
Written by Grace Xiong, Medical Student Class of 2026, McMaster University
Edited by Brindley Brooks
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