7 Common Misdiagnoses for Hidradenitis Suppurativa (HS)

Hidradenitis suppurativa (HS) is a skin condition that often gets caught up in a case of mistaken identity in a lineup of suspects. Specifically, people confuse HS for some more common conditions.

With their host of bumps, rashes, flakiness, or scales, skin conditions can sometimes be tricky to diagnose. That’s because they often share common symptoms or have symptoms that overlap with or mimic those of another skin issue.

So, what exactly is HS? It’s a chronic, progressive skin condition that typically appears as boil-like lumps in friction-prone and sweaty areas, where your skin can be sensitive. These lumps can form interconnected tracts underneath your skin (aka “tunneling”) that may become irritated or even infected.

Knowing how the symptoms of HS compare with those of other inflammatory skin conditions can help you advocate for the correct diagnosis and care, which is crucial for staving off disease progression.

Here are 7 conditions that HS commonly gets mistaken for.

HS isn’t rare — it affects up to 4% of the population. But by comparison, acne vulgaris affects more than more than 9% of people worldwide. Sometimes HS can be mistaken for acne simply because acne is more common. But these two conditions are quite different.

Acne typically shows up as papules, pustules, or nodules, which are commonly called zits or blemishes. Acne most often appears on your face but can also affect your back, chest, arms, and buttocks. It occurs when your sebaceous glands have a hypersensitivity to circulating androgens (like testosterone).

By comparison, HS most often appears in sweat- and friction-prone areas, such as your armpits or groin. It occurs when hair follicles become blocked — though more research is needed to learn what causes these blockages.

Acne conglobata (AC) is a rare but intense form of nodulocystic acne. With AC, the cysts and nodules connect under your skin, and this can lead to infections and scarring. Since AC features a “tunneling” effect that may appear similar to HS, many people confuse these two otherwise distinct conditions.

One key difference? HS often appears in areas that are subjected to friction from skin-on-skin contact or chafing. AC, on the other hand, can appear anywhere on your body. To further complicate things, many people with HS also have AC, and some research suggests a link between the two conditions.

A cyst is a fluid-filled sac. Cysts have many possible causes, including injuries and minor infections. They often go away on their own, but some may require treatment.

HS bumps can resemble cysts — but HS is an ongoing inflammatory condition.

An ingrown hair happens when a strand of hair anywhere on your body grows into your skin instead of out. Ingrown hairs commonly occur after shaving, waxing, or tweezing. After hair removal, a tiny new hair can curl inward, creating a bump (often called a razor bump).

Sometimes people confuse HS bumps for ingrown hairs — especially since HS often occurs in places where hair removal is common, such as the armpits and bikini area. Another confusing factor is that HS develops from blocked follicles. However, the cause of the blockage in HS is more complicated than an ingrown hair.

Folliculitis is inflammation of hair follicles, usually caused by a bacterial infection. The inflamed hair follicles show up as small bumps and can look like ingrown hairs.

People commonly mistake HS for folliculitis because the conditions often occur in the same skin areas.

Mild folliculitis tends to go away on its own with at-home treatment, though more severe forms may require antibiotics. HS, on the other hand, is a chronic condition.

A boil (also called a 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 typically resolves the issue. Meanwhile, the boil-like bumps of HS often require ongoing treatment.

Herpes is a common sexually transmitted infection (STI) caused by the herpes simplex virus. It shows up as painful sores or blisters.

Since herpes often affects the genital area and HS occurs around the groin or bikini line, people may confuse the two conditions. But while herpes can be spread through direct contact, HS is not contagious.

Other skin conditions can mimic HS, and vice versa. But a misdiagnosis can lead to an incorrect treatment that won’t actually ease your symptoms or slow the condition’s progression. This is true for other skin conditions as well.

That’s why, if you have symptoms of any of the above conditions, you should talk with a knowledgeable dermatologist who can properly diagnose your concerns and find the right treatment plan.