Hidradenitis Suppurativa vs. Herpes: What’s the Difference? | myHSteam

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Herpes vs. Hidradenitis Suppurativa: What’s the Difference?

Medically reviewed by Steven Devos, M.D., Ph.D.
Posted on October 2, 2023

Herpes and hidradenitis suppurativa (HS) may look and feel similar, but these two skin conditions have some key differences, including their causes and treatments. Neither condition can be cured, so the symptoms need to be managed for life — and that means getting the right diagnosis so you get the right treatment plan.

Because herpes is caused by a virus (herpes simplex virus 1 or 2), it can be spread from one person to another — for example, genital herpes is considered a sexually transmitted infection. HS, on the other hand, can’t be caught or spread through sexual activity or any other form of physical contact. The cause of HS is less clear-cut, but some people are more susceptible.

Although it’s possible to have HS and herpes at the same time, they have several distinct differences. Here’s what you should know.

Symptoms of Herpes vs. Hidradenitis Suppurativa

Herpes and hidradenitis suppurativa can have some similar symptoms, making it easy to confuse the two.

Type 1 herpes mainly occurs in and around the mouth, and type 2 affects the genitals. However, it’s also possible to develop herpes symptoms in other areas of the body. Oral herpes outbreaks last about a week to 10 days, but a genital herpes flare-up can take two to four weeks to resolve. Along with developing crusty or pus-filled blisters, people with herpes may experience a fever, swollen lymph nodes, and muscle aches.

HS symptoms form near the sweat glands and areas where the skin rubs together, including the armpits, buttocks, breasts, and genitals. Lesions can progress into more severe wounds and tunneling (connections under the skin, also called sinus tracts). HS also can cause painful pea-size lumps and pus-filled bumps that get larger and eventually break open. Complications from HS include limited mobility, chronic and severe pain, scars, swollen lymph nodes, and psychological distress.

Causes and Risk Factors for Herpes and Hidradenitis Suppurativa

The herpes virus can affect people of all races and ages — infection depends on exposure to the virus. There are ways to help prevent transmission, such as practicing safe sex. But it’s also possible to contract herpes from less physical contact, such as sharing lip balm, a razor, or a kiss. Although it’s less common, the virus can spread when symptoms aren’t visible. Many people have herpes with minimal or no signs of infection, so exposure can be difficult to avoid.

The cause of hidradenitis suppurativa is a bit more of a mystery, but certain groups are affected more than others. According to Mayo Clinic, women are three times more likely to have the condition, and Black people have higher rates compared with other racial groups. Usually, people with HS begin showing signs in young adulthood, between puberty and age 40.

Experts believe that genetics probably play a role in who gets HS, but there’s still a lot to be discovered about the disease. Along with having a family history of HS, people are more likely to develop HS if they have a history of smoking and/or medical conditions like severe acne, diabetes, arthritis, inflammatory bowel disease, and metabolic syndrome.

Diagnosis of Herpes and Hidradenitis Suppurativa

Herpes is a relatively common condition. Worldwide, type 1 (associated with oral herpes) affects 67 percent of people under age 50. Hidradenitis suppurativa isn’t nearly as prevalent — researchers estimate that just 0.4 percent of the world’s population has HS — so some doctors aren’t as familiar with it.

Members of myHSteam have reported being misdiagnosed with herpes before learning about HS. “I was told I had herpes back in the ’80s, even though I was practicing safe sexual measures, then later found it was the symptoms of HS,” one member said.

Another member described their long path to diagnosis: “I had no clue that HS was a thing and that there was a community of people who suffer as well. I’ve been dealing with HS since I was 13 years old. I am now 25. I have lived in secret ALL OF THIS TIME. I’ve spoken to care physicians in the past, and they all automatically question if it’s herpes. I’ve been tested numerous times for herpes, and it’ll come back negative. But they insist on continuously retesting as if nothing else could be the answer. This, of course, has made me very frustrated!”

Your health care provider can figure out if you have herpes by taking a swab of the sore and sending it to a lab. They can also do a blood test to see if you’ve been exposed to the virus in the past, even if you don’t have a current outbreak.

Unfortunately, diagnosing HS isn’t as straightforward. An experienced dermatologist can evaluate your symptoms and medical history and do testing to rule out similar conditions. Since it’s possible to have herpes and HS at the same time, it’s important to continue searching for answers if your skin symptoms are significantly affecting your life. If herpes treatment isn’t enough or skin problems progress to more significant and painful lesions, another underlying issue — like HS — may need medical attention.

Treatment for Herpes and Hidradenitis Suppurativa

Your dermatologist can offer a range of treatment options to help control the symptoms of herpes or hidradenitis suppurativa. Both herpes and HS can have periods of flare-ups and remission. Maintaining a healthy lifestyle and seeking treatment as soon as flare-ups begin can help you avoid complications like infections and scarring.

Herpes symptoms range in severity. Some people show few signs of the disease and don’t require treatment. Prescription ointments or antiviral creams such as acyclovir (Zovirax) can help kill the virus and speed healing when applied to the skin during outbreaks. Some people take daily oral antiviral medication to avoid flare-ups of genital herpes.

You can also use at-home remedies to address herpes outbreaks. Treatment approaches include:

  • Applying over-the-counter creams
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Placing ice (covered by a cloth) on the affected area

NSAIDs and ice packs are also helpful for genital herpes. Wearing breathable cotton underwear and soaking in a warm bath can also ease symptoms.

If you have HS, your doctor may suggest various treatment options. For example, topical antibiotics can be applied to the affected skin areas, whereas oral antibiotics may be prescribed for larger infections. Birth control pills may help treat mild HS cases. Your doctor might also suggest the following treatments, depending on your symptoms:

  • Steroid injections to ease swelling and inflammation
  • Retinoids to reduce acnelike symptoms
  • Over-the-counter or prescription painkillers to manage pain
  • Surgery to uncover tunnels or remove inflamed bumps
  • Laser hair removal to treat affected skin
  • Biologics, a class of medications that regulate the immune system for longer-term management of HS

Living With Herpes and Hidradenitis Suppurativa

Both herpes and hidradenitis suppurativa can significantly affect your quality of life, intimate relationships, and self-esteem. Taking time to care for your overall health and well-being is important for lowering stress and preventing flare-ups. You can get helpful ideas, insight, and support by connecting with others who can relate to your experience.

Talk With Others Who Understand

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

Have you ever had a health care provider mistake HS lesions, pimples or cysts for herpes? What self-care tips do you use to manage your skin disease? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on October 2, 2023
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Steven Devos, M.D., Ph.D. received his medical degree and completed residency training in dermatology at the University of Ghent, Belgium. Learn more about him here
Anastasia Climan, RDN, CDN is a dietitian with over 10 years of experience in public health and medical writing. Learn more about her here

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