If you have recurring bumps on hair-growing areas, such as your groin, buttocks, or armpits, you may wonder if they’re folliculitis symptoms or hidradenitis suppurativa (HS). Both conditions cause discolored, painful, oozing bumps that are difficult to tell apart.

Some people are treated for folliculitis for years before being diagnosed with HS, or vice versa. “I’ve had painful bumps on my butt and bikini line for years. I’ve tried benzoyl peroxide and antibiotics, but nothing worked. Is it HS or folliculitis?” one myHSteam member asked.

You may also have both conditions at the same time. In this article, we explain folliculitis symptoms and how they differ from HS.

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What Does Folliculitis Look Like?

Folliculitis appears as small, discolored bumps clustered around individual hairs, sometimes with a white or yellow center.

Here’s how you can differentiate folliculitis from HS.

Color Changes

Both folliculitis and HS lesions look red or pink on white skin. On darker skin, they may appear purple, dark brown, or gray and can be harder to spot until they’ve progressed. However, HS can leave dark patches behind after a flare heals.

Progression

Folliculitis bumps tend to blister and crust over as they heal. HS lesions, on the other hand, may grow larger and deeper over time, forming lumps or bumps under the skin.

When folliculitis doesn’t clear up and keeps recurring in the same spot for weeks or months, it’s called chronic folliculitis. This resembles early HS, which is why even clinicians sometimes confuse the two.

Location

Folliculitis and HS can both develop in areas where skin rubs together, such as the groin, armpits, buttocks, and under the breasts. In these areas, folliculitis tends to cause smaller, surface-level bumps.

HS typically causes deeper, larger, and more painful lumps that can connect under the skin.

Bumps on the face, scalp, beard area, upper chest, upper back, shins, and forearms are likely folliculitis until proven otherwise. These aren’t common HS sites and can help point toward the right diagnosis.

Looking at the size, depth, location, and pattern of your bumps can offer clues, but a dermatologist is in the best position to determine whether you have folliculitis, HS, or another skin condition.

Folliculitis Causes and Risk Factors vs. HS

Despite the overlap in some of their symptoms, folliculitis and HS have distinct causes and risk factors.

Folliculitis is usually caused by a bacterial or fungal infection of the hair follicle, often from shaving, waxing, tight clothing, or a hot tub. You’re more likely to develop it if you have a weakened immune system, have existing acne or dermatitis, or are on certain medications, including long-term antibiotics.

HS, also called acne inversa, isn’t caused by poor hygiene or infection. It’s now considered an autoinflammatory condition, meaning your immune system overreacts and triggers ongoing inflammation. Your risk goes up with:

Researchers are also looking into whether problems with the gut microbiome (the trillions of bacteria in your digestive system) play a role in HS. However, this link is still being studied.

Treating Folliculitis vs. HS

Folliculitis typically clears up on its own or with simple at-home care. Treatment may include:

HS, on the other hand, is a chronic, recurring condition that requires long-term medical management rather than a one-time cure. Common treatments include:

Get Ready for Your Dermatologist Visit

Before your dermatology appointment, it can help to jot down a few details so you don’t forget anything in the moment:

• When your symptoms first started and what the very first bump or lesion looked like
• Whether the bumps have changed over time or in size, number, or location
• If they show up in the same areas of skin each time or in different places
• Any triggers you’ve noticed, like shaving, sweating, tight clothing, or your menstrual cycle
• Your personal history of skin conditions, like acne or eczema
• Any family history of HS, folliculitis, or other skin conditions
• Treatment options you’ve already tried and whether they helped
• Other health conditions you have, like diabetes, IBD, or PCOS
• A list of your current medications