Understanding the Differences Between Hidradenitis Suppurativa and Folliculitis

Living with a skin condition like hidradenitis suppurativa (HS) or folliculitis can be challenging, especially when you’re not sure what’s causing your symptoms.

Here’s what you should know about the differences between HS and folliculitis, and when you should seek medical attention.

HS lesions tend to recur on the same area of skin, according to Faranak Kamangar, MD, a dermatologist at the Palo Alto Medical Foundation in California.

While some symptoms of hidradenitis suppurativa and folliculitis may overlap, each condition tends to follow a separate pattern of symptoms. “It’s important to differentiate between these conditions to treat HS early and avoid it progressing to later stages, which can be debilitating,” says Kamangar.

• Blackheads
• Pea-sized lesions
• Nodules or sores that leak fluid
• Acne- or pimplelike sores

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• Clusters of small red bumps
• Clusters of white-headed pimples
• Larger swollen bumps
• Blisters that break open, leak fluid, and crust over

While early-stage HS can be similar in appearance to folliculitis, HS “has other clues, such as occurring more commonly in skin folds and being more likely to form painful boils,” says Vivian Shi, MD, director of the Hidradenitis Suppurativa Clinic at the University of Washington Medicine in Seattle and an executive board member of the Hidradenitis Suppurativa Foundation.

Here’s how HS and folliculitis may differ in symptoms.

For both hidradenitis suppurativa and folliculitis, the first step in getting an accurate diagnosis is seeing a dermatologist. Dermatologists are trained to spot the differences between these two conditions and any other skin condition that might be causing your symptoms.

“HS and folliculitis are distinguished mainly by the history shared by the patient and how the lesions look,” says Dr. Shi, who adds that HS is often identified by persistent symptoms affecting the same area of skin.

For both hidradenitis suppurativa and folliculitis, the course of treatment your doctor recommends will depend on the severity of your symptoms and whether they resolve on their own or persist. “Treatment of folliculitis can be like treatment of early stages of HS,” says Shi, but more severe HS will need different treatments.

Hidradenitis Suppurativa Treatments

• Antibiotics A liquid or gel applied to the skin can help manage mild HS, while more severe HS can benefit from taking pills by mouth. Antibiotics can help reduce inflammation and resolve infections.
• Steroids Injections of corticosteroids into your lesions can help reduce inflammation and painful swelling.
• Hormone Therapies A number of drugs that affect certain hormones in your body can help reduce inflammation in HS. These drugs may include estrogen or spironolactone.
• Biologics For moderate to severe HS, these injected or infused drugs can disrupt the disease process and improve your symptoms within a few weeks. Three biologics are approved for HS: adalimumab (Humira),

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  secukinumab (Cosentyx),

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  and bimekizumab-bkzx (Bimzelx).

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• Pain Relievers Your doctor may recommend an over-the-counter option or prescribe something stronger if necessary.
• Surgical Procedures Your doctor may use cutting tools or a laser to remove or destroy individual HS lesions, or to remove an area of skin affected by more severe disease. Laser hair removal, a procedure that can help reduce or eliminate hair follicles completely and improve symptoms, may also be recommended.
• Hygiene and Lifestyle Changes Wearing loose clothing to avoid irritating the skin is often recommended. Other measures you can take include keeping affected areas clean and getting laser hair removal to improve symptoms. Losing excess body weight and quitting smoking can also help.

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Hygiene measures for HS are often helpful “not because the skin is dirty but rather to limit hair follicle friction and trauma,” says Shi. Approaches that can help include washing the skin gently rather than scrubbing the area with a washcloth or sponge, and avoiding clothing that hugs or grips the area.

Folliculitis Treatments

When folliculitis doesn’t go away on its own, your doctor may prescribe or recommend the following treatments, depending on what’s causing your folliculitis:

• Antibiotics For bacterial folliculitis, apply a topical antibiotic directly to the affected area or take pills by mouth.
• Antifungals For fungal folliculitis, use an antifungal cream or shampoo.
• Antivirals For viral folliculitis, antiviral medications are recommended.
• Surgical Procedures For severe folliculitis, you may need a minor procedure to drain large boils.

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• Warm Compress Applying a warm compress three or four times daily for 15 to 20 minutes may help relieve discomfort and encourage faster healing.
• Hygiene and Lifestyle Measures Avoid shaving, waxing, or plucking hair in the affected area for 30 days if these activities could have contributed to your infection.

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• Hidradenitis suppurativa and folliculitis both cause inflamed lesions in affected areas, but HS symptoms tend to be more severe and often persist or recur.
• HS tends to affect areas where skin rubs against skin — such as your armpits, your buttocks, or under your breasts — while folliculitis most often affects your scalp, face, arms, or legs.
• Folliculitis may resolve on its own and not require treatment, while HS treatment is necessary to prevent the condition from progressing to a more severe stage.