Hidradenitis Suppurativa vs Folliculitis
Hidradenitis Suppurativa and Folliculitis are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Hidradenitis Suppurativa vs Folliculitis at a glance
- Hidradenitis Suppurativa: Chronic recurrent follicular occlusive disease of intertriginous areas with painful nodules, abscesses, sinus tracts, and scarring.
- Folliculitis: Inflammation of the hair follicle from infection, irritation, or ingrown hairs; presents as follicular pustules and papules.
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Side-by-side comparison
| Feature | Hidradenitis Suppurativa | Folliculitis |
|---|---|---|
| At a glance | Chronic recurrent follicular occlusive disease of intertriginous areas with painful nodules, abscesses, sinus tracts, and scarring. | Inflammation of the hair follicle from infection, irritation, or ingrown hairs; presents as follicular pustules and papules. |
| Classic presentation | Recurrent abscesses + sinus tracts + bridged scarring in axillae and groin; double-comedones.; Painful recurrent nodules and abscesses, often draining purulent foul-smelling discharge; Pruritus, burning, stinging; Sleep disturbance, dyspareunia, gait disturbance, work absences; Significant pain — worst-rated chronic dermatologic disease… | Pruritic follicular papules and pustules in a swimsuit distribution 1-2 days after hot tub use (Pseudomonas); persistent shaving bumps with ingrown hair tips at the beard line (PFB).; Itchy or mildly painful follicular papules and pustules; Bacterial: scattered pustules with central hair on the beard, scalp, thighs, buttocks, axillae;… |
| Workup / key labs | All three required (Dessau criteria): (1) typical lesions (nodules, abscesses, sinus tracts, scars), (2) typical locations (intertriginous), (3) chronic relapsing course.; Clinical diagnosis — no required labs; CBC, CRP, ESR (elevated during flares); Bacterial culture if secondary infection or atypical presentation (cultures often… | Clinical diagnosis based on morphology and exposure history. Culture and Gram stain confirm bacterial etiology; KOH confirms fungal causes.; Usually clinical diagnosis; Bacterial culture and Gram stain of pustule contents when atypical, recurrent, severe, or suspected MRSA; KOH preparation and fungal culture if Pityrosporum, tinea, or… |
| Imaging | Ultrasound (high-frequency) — assesses sinus tract extent, often used to plan surgery; MRI for complex perineal/perianal disease and Crohn overlap; Sinography in selected presurgical cases | Not routinely required; Ultrasound or imaging if abscess or deeper soft tissue involvement suspected (furuncle, carbuncle) |
| First-line treatment | Lifestyle: smoking cessation (most impactful intervention), weight reduction, loose breathable clothing, avoid friction/shaving; Daily antiseptic wash: chlorhexidine 4%, dilute bleach baths, benzoyl peroxide 5-10%; Topical clindamycin 1% solution BID for mild Hurley I disease; Hurley I-II: oral tetracycline antibiotic — doxycycline 100… | Bacterial folliculitis: warm compresses; topical antibacterial wash (chlorhexidine 4%, benzoyl peroxide 5-10%); topical antibiotics (mupirocin 2%, clindamycin 1%) for limited disease; Add oral antibiotics for extensive or recurrent disease: cephalexin 500 mg QID, dicloxacillin 500 mg QID; MRSA suspected → TMP-SMX DS BID, doxycycline 100… |
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