“I had boil-like lumps for several months, and a recent flare-up sprouted blackheads in my inner thighs and armpits,” reported one myHSteam member. People with hidradenitis suppurativa (HS) know firsthand that this skin disease can appear in many ways. HS, also called acne inversa, is a long-lasting skin condition that leads to painful lumps under the skin that look like boils. It frequently affects areas where the skin rubs together, such as the armpits and groin. These lumps become swollen and cause pain, often bursting with oozing fluid and pus.

If you can relate to this condition, you might wonder if the blackheads are caused by HS or if they’re just regular acne. Blackheads with HS are a common concern reported by members of myHSteam, and they can affect your quality of life. If treated improperly, the discoloration and scars that HS blackheads leave behind can make you feel like “a dot-to-dot puzzle,” as described by a myHSteam member.

Blackheads caused by acne and blackheads caused by HS may look and feel slightly different and are treated in different ways. You’ll need to visit a dermatologist to help confirm whether your blackheads are from HS or acne.

What’s the Difference Between Acne Blackheads and HS Blackheads?

Acne blackheads are typically the result of clogged hair follicles. They appear when oil and dead skin cells fill up pores on your skin and create dark, noticeable spots. But for people living with HS, blackheads are more than a blemish.

Symptoms of HS blackheads are more severe. They tend to come in pairs and may have an odor when squeezed out. Extracting them manually can feel painful and creates a chance of leakage. Because HS is a symmetrical skin problem, chances are that if you have blackheads on one side of the body, you’ll have them on the other side as well. “I feel like I have so many blackheads and I can’t get rid of them all,” said one myHSteam member.

If you have HS, you will likely experience other skin symptoms, whereas if you have acne, you may only have blackheads. MyHSteam members know that HS also causes flare-ups with a mixture of pimple-like bumps and large boils on the skin. Ruptured abscesses can lead to hyperpigmentation (darker skin color) and cause deep scarring. These sores can also create tunnels under the skin that are constantly draining.

What Causes Acne Blackheads and HS Blackheads?

Blackheads, whether they’re from acne or HS, do not mean that you have poor hygiene. Acne blackheads get their dark hue because they are partially clogged pores. The oxygen in the air enters your pores and chemically reacts with the melanin pigment in dead skin cells. These types of blackheads are stubborn but preventable by changing your skin care routine and exfoliating once a week.

HS blackheads, on the other hand, may occur for various reasons. Some research suggests that HS is possibly an autoimmune disorder — a disorder in which the body’s immune system attacks its own tissues.

In a study conducted in 2022, researchers noted that individuals with HS had higher levels of autoantibodies. These are proteins created by the immune system, which can mistakenly attack the body’s own cells and tissues, which suggests autoimmune activity.

Family history could also play a role in developing HS and experiencing blackheads as a symptom. Scientists have found an association between the NCSTN gene mutation and recurring clusters of blackheads in people with HS. A 2021 study published in the International Journal of Women’s Dermatology found females are more likely to have HS but with less severity than males. According to the American Academy of Dermatology (AAD), blackhead-like spots often appear in the more advanced stages of HS.

Some environment and lifestyle choices affect your risk of HS in general. People who smoke have almost double the risk of HS compared with nonsmokers. “I quit smoking almost a year ago, and it has helped with my healing process as a whole when I have flares,” said one myHSteam member. Being of a higher body weight is another factor. A 2022 study from the International Journal of Dermatology found people with obesity are three times more likely to have HS.

How Are Blackheads From Acne or Hidradenitis Suppurativa Diagnosed?

To someone unfamiliar with HS, it can be mistaken for other skin conditions such as acne or herpes. A dermatologist could tell you whether your blackheads are from acne or HS. They would conduct a physical examination of your bumps and look for any wounds leaking out fluid and pus. Additionally, your doctor would ask about your medical history, including whether you have any skin cysts and abscesses, where they formed, and if the lumps are painful.

There’s no official lab test to diagnose HS. Instead, your health care provider would take a fluid sample or skin biopsy to rule out bacterial infections or other skin problems.

Identifying acne blackheads is a simpler procedure. A dermatologist or aesthetician would search for any breakouts or dark open bumps on your skin. They would also check if these blackheads cause pain on contact.

Managing and Treating Blackheads From Acne or HS

There are several treatment options for managing blackheads, whether they’re caused by acne or HS. Some of these include:

• Retinoids
• Beta hydroxy acid (BHA) cleanser
• Corticosteroids
• Preventive measures
• Regular dermatologist visits

Retinoids

Your dermatologist can prescribe a topical retinoid, a medication applied to the skin’s surface, to help treat blackheads. Retinoids contain high concentrations of vitamin A, which reduce inflammation and help unclog blocked pores by breaking down dead skin cells and trapped skin debris. Acitretin and isotretinoin are oral retinoids that may be prescribed for the long-term treatment of HS-induced blackheads.

If you have blackheads caused by acne, you can get a prescription for a retinoid from your doctor or purchase an over-the-counter option called adapalene. You might feel a brief stinging sensation when applying the gel, but this is expected, per Mayo Clinic. Pair the retinoid with a nonoily moisturizer afterward to help relieve stinging and other symptoms.

Beta Hydroxy Acid Cleanser

Ingredients like BHA may help keep your blackheads under control. Showering with a body wash or soap containing the BHA benzoyl peroxide can help keep the skin hydrated for people living with HS. It also helps reduce inflammation by lowering the amount of bacteria on the skin.

If your blackheads are caused by acne, the BHA product you’ll want to try is a salicylic acid wash. Start with one that contains between 2 percent and 4 percent salicylic acid and see how your skin reacts. The wash helps to get rid of excess buildup and debris on the skin.

Cleveland Clinic notes that another product for blackheads that you can buy at your local drugstore is an alpha hydroxy acid (AHA) or BHA cleanser that contains 10 percent glycolic acid. Glycolic acid acts as an exfoliator that helps shed dead skin cells. AHAs also promote the growth of new cells, which can help with acne scarring. Dermatologists can perform a gentle fruit acid peel that contains AHAs in concentrations ranging from 20 percent to 70 percent. It removes dead skin cells and improves the appearance of your skin.

Preventive Measures

Prevention is key to making sure that pesky blackheads stay away. Wash your face twice a day with water-based products, and exfoliate the affected areas of the body at least once or twice a week.

People with HS should also try to avoid risk factors that could trigger a flare-up. These precautions include showering after sweating, wearing loose-fitting clothing, and not smoking cigarettes.

Regular Dermatologist Visits

Managing blackheads takes time. If you still haven’t seen a change in your skin after six to eight weeks, consider scheduling an appointment with your dermatologist. If your blackheads are due to acne, dermatologists can perform a manual extraction of stubborn blackheads in a way that won’t damage your skin. Manual extraction, which involves carefully removing blackheads using specialized tools, is typically done by hand to improve your skin’s appearance.

Severe blackheads and HS skin symptoms may prompt your dermatologist to recommend more comprehensive treatment plans or procedures. According to the AAD, steroid injections can help lower inflammation. MyHSteam members have said that prescription treatment options helped improve their symptoms significantly: “It’s been a little over a week since I started taking a corticosteroid along with an antibiotic, and this may be the best I’ve felt in three to four years.”

Although HS blackheads and acne blackheads might look the same, their causes are different. HS blackheads come from a persistent skin condition affecting hair follicles, while acne blackheads usually result from clogged pores due to excess oil and dead skin cells. Getting an accurate diagnosis from a dermatologist is crucial for proper treatment and care.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 35,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Do you have blackheads and HS? If so, how do you manage them? Share your experience in the comments below, or start a conversation by posting on your Activities page.