Knowing the difference could impact your skin care routine.
Pimples and cysts plague most people at some point in their lives, so it’s easy to shrug off your bumpy skin as the acne curse. However, if you’re faced with severe skin problems that seem like more than a stubborn zit, you may not realize that what you might think is a just bad case of garden-variety acne (acne vulgaris) is actually a less well-known form called hidradenitis suppurativa (acne inversa).
“Hidradenitis suppurativa is an inflammatory condition that sometimes may resemble acne,” says Hirshel Kahn, MD, a dermatologist at The Mount Sinai Hospital. “They are both conditions of hair follicles getting clogged up by cells and [oil] which comes off the surface of the skin.” Learn more about what hidradenitis suppurativa is here.
Both conditions are are triggered during puberty and hormone fluctuations, and tend to be more common in women. Here’s how to find out if it’s HS or acne.
1. Location, location, location
While there are some regions on the body that HS and acne share, like the chest and buttocks, most of the time HS lesions appear in places that everyday acne does not. HS is more likely than other kinds of acne to develop in creases of the body: the armpits, groin, breast, and thighs, according to the American Academy of Dermatology. And as you’re probably well aware, acne most commonly pops up on the face, back, neck, shoulders, and upper arms.
2. Severity and pain
Acne can be painful (especially when your skin is irritated from rubbing or picking), but it’s usually not as severe as pain from HS. The pimple-like bumps in HS can grow very deep into the skin, and the pain can be debilitating and significantly affect a patient’s quality of life.
On a 0-10 pain scale, patients with HS typically rated their pain in the range 4–10 and described it as burning, stretching, splitting, throbbing, and aching, according to a 2014 study in Postgraduate Medical Journal.
3. Pus problems
Besides a little white pus if you squeeze a whitehead (don’t do it!), most acne doesn’t typically involve significant leakage. (Psst… Here’s why you shouldn’t squeeze a pimple.)
HS lesions, on the other hand, often leak a bloody or foul-smelling pus that can stain clothing—without your even squeezing or irritating the bumps.
If you notice new developments on your skin—whether you think it’s acne, HS, or something else—it’s important to have a dermatologist evaluate it. A dermatologist’s trained eye can notice the subtle but obvious differences between acne, HS, or other skin conditions.
And this distinction matters: HS is treated differently than acne. Your derm may prescribe antibiotics, steroid shots, or biologic drugs for severe cases of HS, according to Dr. Kahn. Treatment for HS is important and should be done as early as possible to prevent it from worsening and leaving permanent scars.
Dr. Kahn is a board-certified dermatologist and assistant clinical professor at Mount Sinai Hospital in New York City.
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Patients rarely know that they have a
condition called hidradenitis suppurativa.
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They often think they have a rare or
unusual form of acne.
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So, hidradenitis suppurativa
is an inflammatory condition
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that sometimes may resemble acne.
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They are both conditions of hair
follicles getting clogged up by cells and
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sebum, or oil, which comes off the surface
of the skin and may clog up pores.
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Both may have hormonal influences,
which may either cause them or
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cause them to flare up.
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The main features that
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suppurativa from acne
are the location of the lesions,
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the size and
painfulness of the lesions, and
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the leakage of a pussy
fluid from these lesions.
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Acne usually occurs on the face,
but often on the chest and back.
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Hidradenitis suppurativa usually
occurs in the creases, under the arms,
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in the groin creases and
the buttocks, and under the breasts.
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So, hidradenitis suppurativa
lesions are often larger than
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regular acne inflammatory lesions,
sometimes they are cysts.
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They are usually painful,
sometimes extremely painful, and often
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impact the patient's daily activities
because of the pain and discomfort.
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Acne lesions do not typically
have pussy material,
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whereas hidradenitis suppurativa
lesions often have a abundant
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which comes out of the lesions.
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Patients often feel there's nothing
they can do for this condition.
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They've tried everything to treat acne and
nothing has worked.
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But what they don't realize is there are
other treatments that are more specific
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for hidradenitis suppurativa.
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We treat it with antibiotics, we treat
it with, sometimes, shots of cortisone.
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And sometimes we treat it with
more aggressive measures,
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like a group of medications
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These are very different methods
than what we use for acne.
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If you think you have
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it's very important to
see a doctor early on.
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And if it is not treated on,
it may lead to irreversible scarring and
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damage in the area.
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Patients often come in devastated by
this condition and are very grateful and
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relieved when we can give them medication
that's specific to treat this condition.
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Patients often come back
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especially patients that have severe
manifestations of this condition.
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Acne: signs and symptoms. Schaumburg, IL: American Academy of Dermatology. (Accessed on January 20, 2021 at https://www.aad.org/public/diseases/acne-and-rosacea/acne#symptoms.)
Acne: what is it? Bethesda, MD: National Institutes of Arthritis and Musculoskeletal and Skin Diseases. (Accessed on January 20, 2021 at https://www.niams.nih.gov/health-topics/acne.)
Dufour DN, Emtestam L, Jemec GB. Hidradenitis suppurativa: a common and burdensome, yet under-recognised, inflammatory skin disease. Postgraduate Medical Journal. 2014 Apr;90:216-221.Hidradenitis suppurativa overview. Schaumburg, IL: American Academy of Dermatology. (Accessed on January 20, 2021 at https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa.)