Intense skin issues can seem like a bit of a mystery — clues to diagnosis can be confusing when some symptoms and factors are similar. For example, hidradenitis suppurativa (HS) and methicillin-resistant Staphylococcus aureus (MRSA) are both serious, painful skin problems that require medical attention.

Despite sharing several features, these two diagnoses have notable differences. For example, MRSA is a bacterial infection that can be identified with a specific test, whereas HS is a skin condition that’s harder to pinpoint. MRSA is highly contagious, but HS isn’t contagious. Read on for more details about HS and MRSA.

What Is Hidradenitis Suppurativa?

HS is an inflammatory skin condition that’s more common in women than men, according to StatPearls, an online educational resource for medical professionals. This condition typically causes lesions around the armpits, anus, groin, or inner thighs — areas where skin touches other skin. HS causes tender, hard-to-treat skin infections that can lead to permanent scarring.

There’s still a lot that doctors don’t know about HS, but problems typically start with a blocked hair follicle. Blockages from excess oil and skin cells eventually rupture, causing an abscess to form. Pain, burning, and stinging can develop up to 48 hours before a lesion appears. Once lesions develop, they can last anywhere from a couple of days to several months. These deep lumps can break and spread under the skin, leading to bigger issues.

Causes of Hidradenitis Suppurativa

Different factors determine who develops HS and how severe it can be. These associations include:

• Genetics
• Hormones
• Higher body weight
• Smoking

Wearing tight clothes can also make HS symptoms worse by rubbing and pressing on your skin. Loose-fitting clothing that lets your skin breathe can lower the chance of skin irritation.

Stages of Hidradenitis Suppurativa

Cases of HS fall into these three stages:

• Stage 1 — An abscess has formed, but there’s no spreading or scarring.
• Stage 2 — Abscesses are recurrent and have spread under the skin, developing into a pathway and scars.
• Stage 3 — Most skin is affected, with several connecting pathways and abscesses.

Diagnosis and Treatment of Hidradenitis Suppurativa

HS is often mistaken for other conditions. As a result, it can take an average of seven years before HS is diagnosed correctly. The delays usually mean a person is at a later stage when they finally learn what’s causing their skin problems.

In the early stages of HS, skin can be treated with a topical ointment. If this doesn’t work or HS progresses, an oral antibiotic may be prescribed. By the third stage, surgery (combined with antibiotic treatment) may be needed to remove infected areas. Although antibiotics can help, ongoing treatment of HS infections focuses on reducing inflammation and addressing any blood sugar or hormonal imbalances.

What Is MRSA?

MRSA — methicillin-resistant Staphylococcus aureus — is a bacteria that can withstand multiple antibiotics.

The severity of MRSA can vary. If it’s picked up outside of a hospital setting, MRSA will most likely lead to a skin infection or, sometimes, pneumonia. MRSA that’s contracted at the hospital can be much more severe. If left untreated, MRSA can cause sepsis, a life-threatening infection of the blood.

How MRSA looks and feels depends on where it’s located. With a skin infection, MRSA may produce discolored, swollen, painful bumps that can be warm to the touch and full of pus. The bumps may drain, and you may develop a fever.

Risk Factors for MRSA

The risk of MRSA infection is higher in those with:

• Human immunodeficiency virus (HIV)
• Intensive care
• Invasive procedures
• Open wounds
• Prolonged hospital stays
• Recent antibiotic use
• Skin-to-skin contact with another infected person
• Shared equipment during surgeries

MRSA can happen to anyone who’s in close contact with others who have the bacteria. However, it’s often found in older adults who have longer hospital stays or compromised immune systems.

Treatment of MRSA

MRSA is diagnosed through a laboratory test. Treatment choices are based on the severity of the infection. For a less severe infection, an oral antibiotic is used. Doctors may have to try different antibiotics if the infection doesn’t respond to the first one they try.

You can take steps to avoid this bacterial infection in the first place. MRSA may be prevented by:

• Covering wounds until healed
• Laundering towels often
• Not sharing personal items
• Washing hands often

Major Differences Between Hidradenitis Suppurativa and MRSA

HS and MRSA have many more differences than similarities. For starters, MRSA is an infection, and HS is not.

Doctors can usually identify MRSA because of its clear risk factors and available lab tests that can confirm the problem. HS is a rare disease with no specific test. It can also affect different people in different ways.

Another difference involves how these issues start. MRSA infection follows some kind of contact with the bacteria, perhaps from another person or because of unsanitary surgical practices. HS is associated with genetic and hormonal factors — it is not from an outside source but, rather, develops from the inside out.

MRSA can affect multiple parts of the body. In the least severe cases, it appears as a skin infection. However, this bacteria can enter the lungs, bloodstream, bones, and joints, with more serious consequences.

HS typically affects only the upper and lower layers of the skin. It can appear anywhere on the body but is more common in the underarms and groin.

Once MRSA is diagnosed, it can be cured. It’s tough to treat, but most people can get rid of the infection if they get medical attention quickly enough. However, HS is a chronic (longtime) condition, with symptoms that come and go. Flare-ups and periods of remission, when symptoms ease or disappear, aren’t always easy to predict or avoid.

Insights From myHSteam

It’s possible to get MRSA even if you have HS. Members of myHSteam have described their experience with both conditions. In fact, people with HS are more prone to other types of skin infections — including MRSA — because certain areas of skin are already fragile.

“I’ve had MRSA verified by hospital culture,” one myHSteam member said. “What helped long term was not picking it up in public, as drug-resistant germs can be community acquired. I carry a spray bottle of sanitizer and use it when I touch public doors, menus, and anything in public. I use the alcohol just before using the public toilet because I’ve touched the door and don’t want public MRSA germs on my body. Then, after I leave the bathroom, I spray my hands again.” This member also explained how MRSA sores expand rapidly, which can be scary.

If you’re living with HS, you may assume that any skin problem is just another flare, but it’s important to reach out to your dermatologist if you have a newly affected area. And if you have a bacterial infection that’s particularly painful, causing additional symptoms such as a fever, or seems to be spreading quickly, don’t wait to get it checked out.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 40,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Have you experienced a staph infection or other skin disease along with HS? Share your experience in the comments below, or start a conversation by posting on your Activities page.