Folliculitis and HS: What's the Difference?

Hidradenitis suppurativa (HS) can be hard to diagnose because its symptoms may look like many other skin conditions. Folliculitis can often be confused with HS because they both present with bumps on the skin. Making sure you have the right diagnosis is important for getting the best treatment.1,2

Symptoms of HS and folliculitis

HS is a chronic, or long-term, auto-inflammatory skin disease that affects areas of the body that rub together. Early stages of the disease often look like pimples or a rash.1

Commonly affected areas include:1

  • Inner thighs
  • Groin
  • Under the breasts
  • Between buttocks
  • Genital area
  • Armpits

As the disease progresses, deep lumps, called abscesses, can appear. Sometimes they look like a pimple or a boil. These can be very painful, making it hard to sit or even walk. The abscesses can leak blood and pus, and have a bad odor.1

When HS is more advanced it creates blackhead-like dots that often come in pairs. The wounds from HS take a long time to heal. They often reopen again and again. Over time, this causes scarring and tunneling in the skin.1

Many people who have HS are misdiagnosed for years, making it hard to get the right treatment. The symptoms of HS can often be mistaken for the symptoms of folliculitis.1

Folliculitis happens when a hair follicle gets infected with bacteria or fungus. It looks like a bumpy, red rash that can be painful and itchy. It can affect any area of the skin. Sometimes the infected follicles are filled with pus that can spread, infecting other areas.2

Causes of HS and folliculitis

Folliculitis is commonly caused by shaving or being in an unclean hot tub or pool. Some other causes are wearing clothes that are tight, and frequently rubbing or touching your skin. These can all damage the follicle and make it easier for germs to attack the skin.2

No one knows exactly what causes HS. Scientists are still studying why. So far, they know that HS starts when a hair follicle gets clogged with a protein called keratin. Our bodies naturally produce keratin, but when too much protein builds up, the follicle can get infected.1

There is some evidence that HS can be hereditary. It is also more common in women, smokers, and people who are overweight.1

Both folliculitis and HS are common in people with Down syndrome. This may mean there is a link between the 2 conditions, but more research needs to be done.3

Treatment of HS and folliculitis

In healthy people, folliculitis usually goes away on its own. Warm compresses applied 3 to 4 times a day can help the skin heal faster. It is key to stop doing whatever was causing the folliculitis, like shaving, until the infection is gone.2

There are several things you can do to help prevent folliculitis, including:2

  • Wear loose clothing, especially when it is hot and humid
  • Only use a hot tub that you know is clean
  • Wear clean and dry swim or wetsuits
  • Take care when applying medication to the skin. Only apply in the direction of hair growth to avoid clogging the pores.
  • Shave carefully, as shaving can irritate the skin

There is no cure for HS. However, a dermatologist (skin doctor) can help manage the condition in several ways:1

  • Skin care: using gentle cleansers that will not irritate the wounds.
  • Prescription drugs: a number of different drugs are often used to control the symptoms and pain of HS
  • In-office procedures: cortisone shots, laser hair reduction, and other procedures can help improve symptoms
  • Wound care: proper wound care and cleaning can help reduce the odor and pain of HS lesions
  • Pain control: a doctor can recommend or prescribe medicines for pain relief

Without treatment, HS will continue to get worse. The disease can have a serious impact on daily life and well-being. Many people with HS also deal with anxiety and depression as a result of their symptoms.1

Getting the right diagnosis is critical for people with HS. Seeing a dermatologist is the first step in healing and preventing long-term complications.1

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