Hidradenitis Suppurativa vs Herpes: Photos, Symptoms, and More

Two conditions. One confusing question: “Is this hidradenitis suppurativa (HS) or herpes?” If you’re staring at a painful bump and your brain is speed-running worst-case scenarios, you’re not alone. HS and herpes can both show up in sensitive, high-friction areas and can both be uncomfortable. But they’re very different conditions with different causes, different patterns, and different treatments.

This guide breaks down what HS and herpes typically look and feel like, how doctors tell them apart, and what to do next. (Important note: online info can help you ask better questions, but it can’t diagnose you. If you’re worried, a clinician can usually sort this out faster than your search history can.)

Quick Snapshot: HS vs Herpes (The “Wait, Which One?” Checklist)

What Is Hidradenitis Suppurativa (HS)?

Hidradenitis suppurativa (also called acne inversa) is a long-term inflammatory skin condition. It tends to cause painful, deep bumps that form in areas where skin rubs together and where sweat glands and hair follicles are commonthink armpits, groin, inner thighs, buttocks, and under the breasts.

HS isn’t caused by “poor hygiene,” and it’s not contagious. Many people with HS describe it as recurring “boils” that keep coming back in the same general neighborhood like they pay rent there. Over time, HS can lead to scarring and, in some cases, tunnel-like tracts under the skin (often called sinus tracts). Those tunnels are a classic HS clue.

Common HS signs

• Deep, tender nodules (lumps) under the skin
• Boil-like bumps that may enlarge and drain
• Recurring flares in the same areas
• Blackheads in pairs or small pitted areas (in some cases)
• Scarring or thickened skin where flares have happened repeatedly

What Is Herpes (HSV)?

“Herpes” usually refers to infection with the herpes simplex virus (HSV). There are two main types: HSV-1 (more often oral herpes/cold sores, but it can cause genital infection too) and HSV-2 (more often genital herpes). Genital herpes can be symptomatic or completely silentmeaning a person can carry and spread HSV without obvious sores.

Unlike HS, herpes is contagious. It spreads through close skin-to-skin contact, including sexual contact. Outbreaks often come in episodes: sores appear, heal, and may return later (though recurrence varies a lot person to person).

Common herpes signs

• Small blisters that may cluster together
• Sores/ulcers after blisters open
• Crusting/scabbing as sores heal
• Tingling, itching, or burning before sores appear (prodrome)
• Sometimes fever, body aches, or swollen lymph nodes during a first outbreak

“Photos”: What HS and Herpes Typically Look Like

Let’s talk about “photos” without being misleading: images online often show severe, textbook cases. Real life can be subtlerespecially early on, on different skin tones, or when symptoms are mild.

HS appearance (what images often show)

• Deep lumps that look like large pimples or boils, often under the skin
• One or more bumps in a friction area (armpit/groin/inner thigh)
• Drainage may happen if a lesion opens (often described as persistent or recurring)
• Scars or thickened areas where bumps keep returning
• “Tracks” or connected areas beneath the skin in more advanced HS

Herpes appearance (what images often show)

• Clusters of tiny blisters (often grouped rather than a single deep lump)
• Blisters that break open into shallow sores
• Healing that can include crusting/scabbing
• Sometimes surrounding redness and tenderness

If you’re relying on pictures alone, here’s the honest truth: it’s easy to be wrong. HS can look like an ingrown hair or a boil. Herpes can look like a pimple, a scrape, or irritation. When the location is sensitive, it’s worth getting a proper exam.

Symptoms: How They Feel Can Be as Important as How They Look

HS symptoms people commonly describe

• Deep, throbbing tenderness (especially with pressure or friction)
• Pain that makes walking, sitting, or lifting an arm uncomfortable (depending on location)
• Recurrent flares that can last days to weeks
• Drainage and irritation around the area

Herpes symptoms people commonly describe

• Tingling, itching, or burning before sores appear
• Soreness and sensitivity where lesions form
• Pain with urination if sores are near the urinary opening
• “Flu-like” symptoms sometimes during a first outbreak (not everyone)

One practical difference: HS is often described as deep and boil-like, while herpes is often described as surface-level blisters/sores with a distinct “tingle/burn” phase before an outbreak. Not a perfect rulejust a useful clue.

Location Patterns: Where It Shows Up Matters

HS has a strong preference for intertriginous areasplaces where skin rubs, sweat happens, and hair follicles are plentiful: armpits, groin, inner thighs, buttocks, and under breasts. Herpes can occur in or around the genital/anal region and can also appear on the buttocks or thighs. Oral herpes appears around the mouth.

Here’s where people get stuck: HS can affect the groin, and herpes can affect the buttocks/thighs. So location alone won’t solve the mysterybut the pattern and recurrence can help.

Timeline: HS Is a Long Game, Herpes Is Episodic

HS tends to behave like a chronic condition with flaressome people have mild, occasional bumps; others have frequent, painful episodes. Lesions can recur in the same areas, and scarring/tunnels can develop over time.

Herpes tends to come in outbreaks. The first outbreak (if symptoms occur) is often the most noticeable, and later outbreaks may be milder. Some people have rare recurrences; others have more frequent ones. Importantly, HSV can still be present and transmissible even when the skin looks normal.

Contagiousness: A Key Difference for You and the People Around You

HS is not contagious. You can’t “catch” it from someone, and you can’t give it to a partner by contact. Herpes is different: HSV can spread via skin-to-skin contact, including when there are no obvious sores (asymptomatic shedding is a known factor).

If you suspect herpes, it’s smart to avoid intimate skin-to-skin contact in the affected area until you’ve been evaluated. If you suspect HS, the focus is more on reducing friction/irritation and getting the right treatment plan.

How Doctors Tell HS From Herpes

Clinicians usually start with a detailed history and a physical exam. Then they look for key features:

Clues that point toward HS

• Recurring painful lumps in the same friction areas
• Scarring, blackheads in pairs, or tunnel-like tracts
• Long-standing pattern of flares over months/years

Clues that point toward herpes

• Clusters of blisters/ulcers, especially with a tingling prodrome
• New sores that appear and heal in a more predictable outbreak cycle
• Exposure risk (not always known) and recurrent episodes

Testing

• Herpes: A swab test from a sore (often NAAT/PCR) can confirm HSV. Blood tests can show HSV antibodies, but they don’t always clarify timing or whether symptoms match the result.
• HS: There’s no single “HS blood test.” Diagnosis is usually clinical (based on what it looks like, where it happens, and whether it recurs). Sometimes a clinician may test drainage to check for secondary bacterial infection.

Treatment: What Helps HS Won’t Treat Herpes (and Vice Versa)

This is why accurate diagnosis matters: HS is primarily treated as an inflammatory skin disease, while herpes is treated with antiviral medication.

HS treatment options

• Topical treatments: topical antibiotics in certain cases
• Oral medications: antibiotics (for inflammation and secondary infection), hormonal approaches for some patients, and other anti-inflammatory strategies
• Biologics: for more moderate to severe HS, certain injectable medications may be used under specialist care
• Procedures: steroid injections into lesions, drainage in select situations, or surgical approaches for persistent tunnels/scarring
• Long-term plan: HS often improves with a consistent, personalized strategy rather than one-off fixes

Herpes treatment options

• Antivirals: medications like acyclovir, valacyclovir, or famciclovir can shorten outbreaks and reduce recurrence
• Suppressive therapy: daily antiviral medication may reduce outbreak frequency and lower transmission risk
• Episodic therapy: starting antiviral medication early (when symptoms begin) can help reduce severity and duration

One more thing: antibiotics don’t treat herpes (it’s viral), and antivirals don’t treat HS (it’s not HSV). If you’ve tried repeated antibiotics and the same “boils” keep coming back, that’s a good reason to ask about HS specifically.

Self-Care Tips That Make a Real Difference

Self-care can’t replace medical treatment, but it can reduce irritation and help you feel more in control.

HS-friendly habits

• Use gentle cleansing; avoid aggressive scrubbing (it can worsen inflammation)
• Reduce friction with breathable, loose-fitting clothing
• Be cautious with shaving/waxing in flare-prone areas
• Consider warm compresses for discomfort
• If relevant, discuss weight management and smoking cessation with a clinician (these can influence HS severity)

Herpes-friendly habits

• Keep the area clean and dry; wear loose, soft clothing
• Warm baths can ease discomfort for some people
• Avoid picking at sores (it delays healing and increases irritation)
• Ask about antivirals if you suspect herpesearly treatment can help

When to Get Medical Care Quickly

It’s worth getting checked sooner rather than later if:

• This is your first episode of genital-area sores or painful lumps
• You have fever, rapidly spreading redness, severe pain, or feel very unwell
• You’re pregnant or immunocompromised
• You have recurring painful lumps that leave scars or seem to form “tracks”
• Symptoms are affecting daily life (sleep, walking, school/work, mental health)

FAQ: Common Questions People Ask (Out Loud and in Their Heads)

Can HS show up “down there”?

Yes. HS commonly affects the groin and inner thighs. That can be alarming, but it’s a known pattern for HS.

Can herpes look like one bump?

It can start subtlyespecially early in an outbreak. But herpes often forms clusters of small blisters that become sores, rather than a single deep, boil-like lump.

Can you have both HS and herpes?

Yes, it’s possible to have HS and also have HSV. If symptoms don’t fit neatly into one box, that’s another reason a clinician’s exam and testing can help.

If it keeps coming back in the same spot, what does that suggest?

Both can recur, but HS commonly returns in the same friction areas and may leave scarring or tunnels over time. Herpes recurs as outbreaks, often with a similar “prodrome → sores → healing” cycle.

Conclusion: Focus on Pattern, Not Panic

HS and herpes can look similar at a glance, especially in sensitive areas. But the big differences are cause (inflammatory follicle disease vs viral infection), contagiousness (HS no, herpes yes), and pattern over time (HS chronic flares with possible scarring/tunnels vs herpes outbreaks of blisters/sores).

If you’re unsure, the best next step is simple: get evaluated. A clinician can often tell a lot from the pattern and location, and herpes testing can confirm HSV when needed. Either way, you deserve clear answersand a plan that actually works.

Experiences: What People Commonly Go Through (and What Helps)

(This section shares common experiences people report. It’s not a substitute for medical carejust a way to feel less alone and more prepared.)

1) The “I Thought It Was Just an Ingrown Hair” phase. Many people with HS say their earliest flares looked like a single stubborn bumpmaybe after sweating, tight clothing, or shaving. It doesn’t drain like a typical pimple, it’s deeper, and it hurts in a way that feels unfair for something so small. A common experience is treating it like a random boil for months (or years), only to realize the patternsame areas, repeating flareswas the real clue.

2) The frustration of mixed messages. HS is often misunderstood. People report being told to “wash better,” “stop shaving,” or “use acne cream,” and then feeling defeated when nothing changes. On the herpes side, people often describe a different kind of stress: the fear and stigma around a possible STI. Even when symptoms are mild, the uncertainty can feel loud. Both conditions can trigger anxiety because they affect intimate areas and can come back unexpectedly.

3) The relief of a nameand a plan. Getting a diagnosis can be emotional. For HS, people often feel validated when someone finally says, “This is HS,” because it explains the pattern and opens the door to real treatment options. For herpes, confirmation can feel scary at first, but many people describe relief once they understand that HSV is common, manageable, and that antiviral medication can reduce outbreaks and lower transmission risk.

4) Learning triggers without turning life into a science fair. People with HS often experiment (gently) with changes that reduce friction and inflammation: looser clothing, breathable fabrics, careful hair removal choices, and keeping a “flare diary” to spot patterns. People with herpes commonly notice triggers like stress, illness, or lack of sleep. The helpful mindset is “pattern recognition,” not perfectionbecause nobody needs a new full-time job called Managing Skin Drama.

5) Communication and mental health matter. A big shared experience is the emotional weightpain, embarrassment, and worry about relationships. People often say that support (a clinician who listens, a trusted friend, a support group, or a counselor) makes a real difference. Practical preparation helps too: taking photos to track changes (for your doctor), writing down questions, and showing up to appointments with clear notes like “how often,” “where,” and “what it feels like.” Those details can speed up the right diagnosis and treatment.

6) The “I’m not broken” moment. Over time, many people reach a calmer place: HS becomes something they manage with a plan, and herpes becomes something they treat and live withnot a label that defines them. If you’re in the uncertainty stage right now, that calmer stage is possible. Your job is not to self-diagnose perfectly. Your job is to get support, get answers, and get a plan that helps you feel better.