People with hidradenitis suppurativa (HS) sometimes receive misdiagnosis for other conditions, including folliculitis and acne. A dermatologist can make an accurate diagnosis.

Hidradenitis suppurativa (HS) is an inflammatory skin condition. It causes painful lumps to form under the skin.

The exact cause of HS is unclear. The condition occurs when hair follicles fill with keratin, sweat, and bacteria, and become blocked and inflamed. These lumps can burst open, which can lead to infection, and they often leave scar tissue when they heal.

In the early stages, HS looks like small red bumps on the skin. HS is more likely to happen in places where skin rubs against skin, such as the buttocks, breasts, and underarms, and around the genitals.

As it progresses, the inflammatory process can cause follicles to expand and join with each other. This can create tunnels under the skin, which can also spread inflammatory cells and become very painful.

Misdiagnosis often happens with HS, especially in the early stages. This leads to delays in proper treatment. Because of the delay in diagnosis, many people are diagnosed at a more severe stage of HS.

One of the reasons for the delay in getting a proper diagnosis is that HS can look like other skin issues. Scheduling an appointment with a dermatologist, a specialist in diagnosing and treating skin conditions, can help determine whether you’re experiencing HS or something else.

Read on to learn more about some common misdiagnoses for HS.

Acne vulgaris, or acne, is a common skin condition. Acne can be a combination of pimples, blackheads, whiteheads, and cysts.

Some people have skin that produces more sebum, the skin’s natural oil. This may make them more prone to acne. Acne occurs when pores fill with dead skin cells and sebum. When pores are blocked, they become inflamed, leading to acne.

The early stages of HS can look like acne. Both conditions can cause small red bumps on the skin’s surface. But the location of the red bumps is often different in HS and acne.

Acne is most common on the face, and it can also appear on the back, shoulders, and chest.

HS is typically more painful than acne. Acne may cause some pain and swelling, but usually not as much as HS. Poking and popping acne can cause some of the spots to burst, but they won’t typically burst open on their own. HS bumps get so inflamed that they often burst on their own.

Acne conglobata is a rare and more severe form of acne. Pores fill with dead skin cells and oil and become inflamed.

In acne conglobata, inflamed pores expand below the surface. The inflamed pores join with each other, spreading inflammation. This is similar to how inflammation spreads in HS.

Acne conglobata and HS can look very similar. Both conditions can cause significant scarring.

Acne conglobata is often diagnosed based on personal medical history. It’s more likely to develop in someone who is using anabolic steroids or taking thyroid medication, or those who’ve had androgen-producing tumors or exposure to halogenated aromatic hydrocarbons.

HS and acne conglobata can affect some of the same sites, but there are also differences. Acne conglobata typically affects the:

  • face
  • chest
  • shoulders
  • thighs
  • upper arms

Both acne conglobata and HS can be present on the buttocks, but HS is more likely to occur where skin rubs together.

A cyst is a lump on your skin that is filled with yellow or white fluid and debris. It commonly appears on the head, face, back, chest, and neck, but can sometimes occur in other areas as well.

Cysts can be caused by different things. They can be a part of HS, but there are other reasons you may get a cyst.

In some cases, cysts show up with no obvious cause. They may be more likely to develop if you have acne.

Cysts may cause discomfort or pain. They may burst and then grow again, typically in the same site, though they don’t always come back.

Ingrown hairs happen when a hair curls back down into the follicle instead of growing out. Follicles blocked by ingrown hairs can be itchy. Sometimes, you can see a bit of pus or the hair trapped inside.

Ingrown hairs are most likely to happen after hair removal, such as waxing or shaving. They’re also more common if your hair is coarse or curly.

You might get multiple ingrown hairs in the same area after hair removal, as the hair starts growing back.

Unlike HS, ingrown hairs don’t always need treatment and often resolve on their own.

Folliculitis occurs when a hair follicle becomes infected or inflamed, leading to a bump or pustule. This can occur when the hair follicle is damaged, commonly as a result of:

  • wearing tight clothing
  • shaving
  • waxing
  • being in a hot tub

Damage to the hair follicle makes it more prone to infection.

The early stage of folliculitis looks like small, inflamed spots. It may feel itchy or painful, or you may not feel anything. Early HS is more likely to be a lump under the skin or small, tender bumps.

Folliculitis can happen anywhere you have hair follicles, which is most of your body. It often goes away on its own within a few weeks. If not, the infection can spread, making the bumps larger and filled with pus.

Meanwhile, HS typically doesn’t go away on its own without treatment.

HS can cause boils, but not all boils are a result of HS.

Boils are pus-filled skin infections that occur around a hair follicle or oil gland.

A boil starts when a hair follicle and the surrounding tissue become infected by bacteria such as Staphylococcus aureus. Damage to the skin from a bite or injury can make you more likely to develop a boil in that spot.

Boils are most likely to happen on your neck, face, buttocks, and thighs. They can also occur on the groin, genitals, thighs, and armpits. Several of these places are also common sites for HS.

Boils can also grow until they burst and can spread infection. With HS, as the condition progresses, multiple boils can grow and swell until they connect. This can create tunnels under the skin that spread the inflammation.

Sometimes, a boil resolves without medical treatment. Other times, it keeps coming back and needs treatment to prevent it from forming again.

People with hidradenitis suppurativa (HS) often initially receive a misdiagnosis. This is because symptoms can often resemble those of other skin conditions. It can mean that many people are at a more severe stage of HS by the time they receive an accurate diagnosis.

A dermatologist is a doctor who specializes in skin care. They’re the best person to make the right diagnosis and determine the best course of treatment.

If you’re receiving treatment for a skin condition but it’s not getting better, reconnect with your dermatologist. If it’s HS, getting the right diagnosis sooner can help prevent it from progressing and improve your quality of life.