6 Conditions HS Pretends to Be

Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin condition, and for long-time sufferers, it’s the kind of condition that can really hit hard when you least expect it. Characterized by painful nodules, abscesses, and scarring, HS is also a bit of a chameleon. In other words, it can be easy to mistake it for other things.

Are you noticing unusual skin problems under your armpits, groin, or breasts? Although HS only affects up to four percent of the population, it is often misdiagnosed due to its symptom overlap.

Not sure if you have a more common condition like acne or if it’s HS?

Don’t worry. We’ll break down the six conditions HS mimics, go over their distinguishing features, and discuss how you can get the accurate diagnosis and timely intervention you deserve.

1. Acne Vulgaris

Acne vulgaris is a common skin disorder affecting 85 percent of adolescents and young adults. In other words, it’s highly prevalent. If you haven’t heard of it or seen it yourself, acne vulgaris basically presents with comedones (blackheads/whiteheads), papules, pustules, and sometimes nodules. These can occur regularly on the face, chest, or back, and given the occurrence of nodules and pustules, can easily be confused for HS.

Mild HS, specifically, known as Hurley Stage I, has limited abscesses and scarring, making it even easier to mistake for some form of acne. Add in the fact that both conditions involve inflammation and can occur in similar age groups, and it’s often difficult to diagnose properly.

But here’s where you can tell the difference.

Acne vulgaris primarily affects sebaceous gland-rich areas on the face and upper trunk. HS, by comparison, targets apocrine gland regions like the groin and armpit. Then there are the lesions themselves. With HS, lesions are deeper, more painful, and recurrent. Acne, however, shows superficial comedones.

It’s also important to note that HS lacks true blackheads, with discharging lesions, whereas acne does not show that type of discharge. If you additionally notice “rope-like” scarring patterns, it’s more likely to be HS than acne. Acne will respond to topical retinoids, but HS requires systemic therapies like antibiotics or biologics. If the condition persists beyond adolescence and recurs in the armpits, groin, nipples, and around the anus, it’s much more likely to be HS.

2. Folliculitis or Boils

Folliculitis is basically an infection of hair follicles, while boils (furuncles) present as red, painful nodules or abscesses. Because of this appearance, these can resemble HS’s early lesions, with recurrent boils in moist areas frequently mistaken for HS.

In patients with risk factors like obesity or diabetes, this is especially the case.

Here’s the difference, though. Folliculitis is typically superficial, involving hair follicles across the body, like the scalp or thighs, and will go away with better hygiene or antibiotics. Moreover, boils are solitary or clustered but don’t have the chronic sinus tracts and scarring found in HS. In fact, research indicates that HS lesions often last for weeks, vs. days for boils.

HS also correlates with systemic inflammation markers, which your doctor or dermatologist can detect with various tests. If you have sinus tracts or scarring, it’s probably HS, and if it chronically recurs, it’s almost certainly HS, not boils or folliculitis.

3. Ingrown Hairs

Ingrown hairs occur when hair curls back into the skin, causing painful, inflamed bumps. They are most common in shaved areas such as the groin or armpit, and like to mimic HS’s early nodules, particularly in patients with curly hair who frequently shave.

Of course, the main difference is how ingrown hairs come about. They are closely tied to hair removal practices and can be resolved, in most cases, simply by cutting back on those hair removal practices. They may also resolve, in more severe cases, with laser epilation.

Compared to HS, ingrown hairs lack the deep abscesses and sinus tracts. HS lesions are also larger, more painful, and recur independently of shaving, often becoming scars with time.

So take a brief assessment period. Assess for shaving history and lesion depth. HS will persist no matter what you do about your shaving.

4. Herpes Simplex Virus (HSV)

Genital HSV typically presents with painful, recurrent vesicles or ulcers in the groin. Like HS, HSV can cause burning pain and swollen lymph nodes, making them harder to differentiate.

Fortunately, with a close diagnostic eye, it’s not that hard to tell the difference between the two conditions. HSV lesions are always superficial and will usually crust over within 7-10 days. HS, however, forms deeper nodules or abscesses that last weeks.

HS also lacks HSV’s unique symptoms, such as tingling and fever.

Want a simple way to break it all down? Order HSV PCR for genital lesions, and you should be able to quickly differentiate HS’s chronic, scarring nature from HSV’s more transient patterns.

5. Cutaneous Crohn’s Disease

Cutaneous Crohn’s disease is a rare manifestation of inflammatory bowel disease, and it can present with nodules, abscesses, or fistulae, which are abnormal passageways beginning from inside your anus and actually developing to the skin outside.

This is similar to what happens to some people with HS, and is made even harder to differentiate, given that both conditions also present with chronic inflammation. In fact, research finds that chronic inflammation has an overlap in HS and Crohn’s patients.

Fortunately, you don’t need to be a detective to find the differences! Cutaneous Crohn’s often also comes with gastrointestinal symptoms, everything from diarrhea to bloating, nausea, and abdominal pain. This is usually not the case with HS, however, which is primarily dermatologic.

You should also note that HS lesions are usually symmetric and occur around sweat glands. Crohn’s lesions, by contrast, are typically asymmetric and occur around the anus. Colonoscopies and other imaging techniques can help confirm if it’s Crohn’s or something else.

The main thing you should do is get screened for gastrointestinal symptoms, especially by ordering biopsies. A biopsy can reveal the presence of granulomas, which are collections of immune cells characteristic of Crohn’s. These granulomas are not a distinguishing feature of HS.

6. Cysts

Various types of cysts can be mistaken for HS. This happens because both sebaceous and sacrococcygeal cysts show a lot of overlap. If you’re not familiar with these terms, sebaceous cysts are basically noncancerous lumps or bumps under the skin that appear all across the body where oil glands exist. Sacrococcygeal cysts, meanwhile, are located near the tailbone and result from infection of the hair follicles.

In many cases, these cysts can greatly mimic HS’s painful abscesses. Both cysts and abscesses can also rupture and become infected, making the symptoms overlap even more.

If you’re not sure where to begin, consider the location of the skin issue. Cysts are often mobile and clearly defined, but they will not chronically recur like problems with HS. The lesions of HS are also more inflammatory and prone to scarring.

Because it can be difficult to distinguish based on the eye alone, you should consider tests like an ultrasound. While HS often presents with fluid-filled tracts, cysts usually present as abnormal sac-like growths.

Again, the use of an ultrasound can help discern the key differences. HS has multiple lesions in different areas, especially associated with the sweat glands. Cysts, however, are usually solitary and localized. A keen dermatologist can perform the necessary tests to get to the bottom of it.

Although Hidradenitis Suppurativa loves to mimic similar skin conditions, getting a proper diagnosis does not have to be too difficult. With a detailed medical history, targeted exams, and crucial imaging and biopsies, you and your doctor can figure out what’s going on early and fast, when it matters most!

By Evan Bollinger | Published September 21, 2025