If you’ve been diagnosed with hidradenitis suppurativa (HS), you likely had a long journey to get there. One study found that the average wait for a diagnosis was 10 years.¹ Part of the reason HS can be so difficult to diagnose is that the symptoms of HS can be mistaken for those of other medical conditions.² This article will review some of the more common health conditions that HS may be mistaken for, including acne, boils, folliculitis, and ingrown hairs.

How Is Hidradenitis Suppurativa Diagnosed?

No specific medical tests can be used to diagnose HS. This means that diagnosis relies on your healthcare provider’s ability to identify the signs and symptoms of HS. That’s why HS is often diagnosed by a dermatologist — a healthcare provider who specializes in diagnosing and treating skin conditions.²

To help diagnose HS, your dermatologist will ask questions about your symptoms and examine any lumps or inflamed areas of skin (lesions).² They’ll look for factors that indicate HS, such as³:

• Lesions in your armpit (underarms), under your breasts, in your genital area, and around your inner thighs
• Individual lumps that join and fill with pus (called abscesses)
• Bumps that look like double-headed blackheads
• Abscesses that burst and leak strong-smelling fluid
• Lesions that leave scars
• Lesions that keep coming back

Continue reading to learn more about the different skin diseases that HS may be mistaken for.

Acne

At first glance, HS can look and seem like acne.² Additionally, medical terms for these conditions are similar — acne inversa for HS and acne vulgaris for acne.^4,5 However, HS is not acne.

Acne occurs when pores become clogged with sebum (oil), dead skin cells, or bacteria, causing a pimple (pus-filled bump). Acne and HS generally affect different parts of the body. The face usually first comes to mind when you think of acne, but pimples can also show up on the shoulders, back, and chest.⁵ HS, on the other hand, is generally found under the arms or breasts and around the genitals and inner thighs.³

HS symptoms can sometimes resemble an acne breakout.³

Boils

HS lesions can be mistaken for boils, but they’re not the same.² A boil is a pus-filled bump caused by a skin infection, often by the bacteria Staphylococcus aureus. The medical term for a boil is furuncle. A cluster of several boils is called a carbuncle.⁶

Boils look like discolored bumps on your skin that quickly grow in size over a few hours or days. The bumps may have a yellow or white head in the center. You may also notice that the boil oozes pus and forms a crust on top. As the boil grows, it can become painful.⁶

Because boils are caused by a bacterial infection, they’re contagious. This means the infection can be spread to other parts of your own body or to other people.⁶ HS is not contagious — you can’t spread HS to another person by physical contact.⁷

Boils and HS share some symptoms, such as wounds that can leak pus.^3,6 To tell the difference between HS and a boil, your healthcare provider may take a sample of the fluid from a boil to test for bacteria.²

Folliculitis

Folliculitis occurs when a hair follicle becomes inflamed. Like boils, folliculitis can be caused by an infection. Folliculitis can also be caused by medications or a physical injury.⁸

Folliculitis may be mistaken for HS because HS often starts in areas where hair grows, such as your armpit and groin.³ Additionally, the symptoms of folliculitis may be similar to HS, including⁸:

• Inflamed bumps that appear near hair follicles
• Lesions that fill with pus and leak fluid
• Itching, pain, or tenderness

Your healthcare provider may be able to tell the difference between HS and folliculitis by examining the area and testing for infection.⁹

Ingrown Hairs

Ingrown hairs can develop when your hair begins to grow into your skin after you shave or wax.¹⁰

An ingrown hair may look like a small bump with skin irritation and discoloration. Ingrown hairs can become infected, causing them to fill with pus and become more painful.¹⁰ Ingrown hairs can sometimes look like other conditions, such as folliculitis or HS.⁸

You might get an ingrown hair in any part of your body where you remove hair. Some places where ingrown hairs often develop are also areas of the body where HS commonly occurs, including^3,10:

• The armpits
• The inner thighs
• The groin
• The buttocks

A myHSteam member shared, “It took me almost two years to be referred on the NHS to dermatology. My previous GPs misdiagnosed me as having ingrown hairs.”

Talk to Your Healthcare Provider

Several myHSteam members have experienced delays in their diagnosis. One member shared, “I didn’t know what I had for almost 30 years! I was misdiagnosed.”

A diagnosis in the early stages of HS can help you manage your symptoms and prevent complications.^2,4 Talk to your healthcare provider about your treatment options for HS and other skin conditions.