What Is the Difference Between Hidradenitis Suppurativa and Herpes?

Hidradenitis suppurativa (HS) and herpes simplex virus (HSV) both cause painful sores. However, they have several key differences, including where the sores appear, how they spread, their causes, and treatment options. HS is also very rare, while herpes is common.

You can have both HS and HSV at the same time. However, because of their differences, it is important to get the correct diagnosis and treatment.

Symptoms of Hidradenitis Suppurativa vs. Herpes 

Hidradenitis suppurativa (HS) forms deep, pus-filled lumps in areas that rub together, often causing tunneling (sores that connect under the skin) and scars. They may look like pimples initially but can turn into boils or abscesses that fill with pus (yellow drainage).

Herpes causes small blisters that cluster together around the mouth or genitals. Both HS and herpes can cause discomfort or tingling in the area before sores develop. Unlike HS, herpes sores usually don't leave scars.

Differences

Hidradenitis and herpes simplex virus affect different body areas and have unique causes, transmission, risks, triggers, prevalence, diagnoses, and treatments.

Prevalence

Hidradenitis suppurativa is rare, affecting less than 1% of the population. HSV-1 is more prevalent (common), affecting 67% of people worldwide. HSV-2 affects about 13% of adults. 

Location of Sores

HS and HSV sores generally appear in different areas.

• HS affects areas with sweat glands like the armpits, groin, under the breasts, thighs, and buttocks. Sores occasionally occur near the genitals or anus.
• HSV-1 (cold sores or fever blisters) appear on the lips, around the mouth, or on the genitals.
• HSV-2 (genital herpes) affects the genitals, buttocks, and anus. 

It's uncommon for HS to appear around the mouth, so you are less likely to confuse it with HSV-1. (It might be mistaken for acne.) However, HS sores near the genitals or anus might be mistaken for HSV-2. 

Causes and Risk Factors

The exact cause of hidradenitis suppurativa isn’t known, but genes, hormones, and the immune system play a role. Infection and inflammation in the sweat glands, as well as hair follicle blockage, lead to sores.

HS risk factors include:

• Family history (up to 40% of people with HS have a first-degree relative with HS)
• Obesity
• Smoking tobacco
• Being assigned female at birth
• Being a teenager or in your 20s or 30s
• Metabolic syndrome (a group of conditions—including high blood pressure, high blood sugar, and abnormal cholesterol—that increase your risk for diseases such as heart disease, stroke, and type 2 diabetes)

Risk factors for HSV-1 include close personal non-sexual contact with someone with HSV-1, especially during childhood.

Risk factors for HSV-2 include: 

• Unprotected sex with an infected partner
• Multiple sexual partners
• Weakened immunity 
• Being assigned female at birth 
  

Transmission

Hidradenitis suppurativa isn't contagious. The exact cause is unknown, but a combination of biological and environmental factors can trigger symptoms.

Herpes simplex virus is infectious and highly contagious. It spreads through direct contact with someone with HSV. Some people with herpes don't have symptoms, making it challenging to avoid spreading it. 

You can get HSV-1 by sharing utensils, lip balm, or kissing. HSV-1 can also cause genital sores through oral sex. HSV-2 mainly spreads through sexual contact. In rare cases, you can pass the virus to your newborn during childbirth. People with HSV-1 can get HSV-2, and vice versa.

Triggers

A trigger is something that can cause a flare-up. Stress, fatigue, illness, and hormone changes are common triggers between HS and HSV.

Other HS triggers include:

• Friction from tight clothing 
• Hot weather
• Rubbing skin

Other HSV triggers include:

• Physical trauma (e.g., dental procedures)
• Sexual activity (skin irritation)
• Sun exposure

Comorbidities

Comorbidity means having more than one health condition at the same time. While this is not an exhaustive list, HS comorbidities include: 

• Autoimmune conditions
• Chromosome abnormalities
• Depression
• Anxiety
• Diabetes
• Heart disease
• Herpes zoster (shingles, reactivation of chickenpox)
• Hypertension (high blood pressure)
• Hormonal imbalances, including thyroid disorder
• Liver or kidney conditions
• Sexual dysfunction
• Skin conditions

HSV comorbidities include:

• Cervical cancer
• Human immunodeficiency virus (HIV)
• Sexually transmitted infections (STIs)
  

Diagnosis and Treatment

Providers diagnose hidradenitis suppurativa through an exam, blood tests, and imaging scans. They diagnose HSV by swabbing the sore to detect the virus's genetic material or a blood test to check for antibodies. Treatment for both focuses on reducing symptoms and outbreaks. 

HS treatments include:

• Antibiotics to treat infection and reduce lumps
• Biologics to regulate the immune system
• Emotional support
• Hormones
• Laser hair removal to reduce lumps
• Lifestyle changes (e.g., quitting smoking)
• Pain control
• Resorcinol or retinoids (vitamin A derivatives that helps unclog pores and reduce inflammation)
• Steroid injections into lumps to reduce inflammation
• Surgery for severe cases with tunneling

In addition to home remedies and cold sore creams, HSV treatment involves antiviral medications like Zovirax (acyclovir). Antivirals stop the virus from multiplying. You can take them daily for prevention or during outbreaks.

Some people use essential oils like peppermint, tea tree, and eucalyptus when they feel a sore developing. However, it’s important to use caution when using essential oils directly on the skin, without a carrier oil, as they can cause burning. 

Similarities

Despite their differences, hidradenitis suppurativa and herpes simplex virus are both chronic (long-term) conditions that may involve a prodromal phase and affect quality of life.

Chronic

Both HS and HSV are chronic conditions without a cure. Each can range from mild to severe flare-ups. Outbreaks can be frequent or occasional, lasting days to weeks.

Prodromal Phase

The prodromal phase is when early signs begin, before sores develop.

About 83% of people with HS notice flu-like symptoms or tingling and discomfort in the affected area about 12-48 hours before the sores.

HSV prodrome may include flu-like symptoms but frequently involves tingling, burning, or itching where blisters will appear, typically 12-24 hours beforehand.

Effect on Quality of Life

HS and HSV can be uncomfortable and worrying. They can affect intimacy, relationships, work, and social life. Both can be embarrassing or emotionally stressful and can affect self-confidence and self-esteem.

Can You Have Both Hidradenitis Suppurativa and Herpes?

You can have hidradenitis suppurativa and herpes simplex virus because they have different causes. Here’s a quick summary of how you can tell them apart:

• HS is likely due to genetics and immune system changes. HSV is a virus.
• HS isn't contagious, but HSV is. 
• HS is rare, while HSV is common.
• HS appears in areas with sweat glands and friction. HSV-1 affects the area around the lips and mouth. HSV-2 affects the genitals and anus.
• HS causes deep bumps that can grow together and leave scars. HSV causes shallow, itchy blisters that cluster and heal without scars.

When To Seek Care and Who to Contact

Reach out to a healthcare provider if you have any of the following symptoms:

• Blisters or sores around your mouth, genitals, or anus
• Flu-like symptoms 
• Painful, deep bumps under your skin

If you have HSV, your provider can oversee your treatment. In severe cases, they might send you to a gynecologist (a doctor who specializes in female reproductive health) or a urologist (a doctor who specializes in urinary and male reproductive health). Because HS is rare, they might refer you to a dermatologist (skin specialist) with an HS specialty.

Some insurance plans require a referral from your primary care provider (PCP) before seeing a specialist. Check your healthcare plan for the details. You can also check national organizations like the American College of Obstetricians and Gynecologists (ACOG) to find a reputable specialist or use directories like the following to search by specialty, location, insurance, and patient reviews:

• Healthgrades
• Medifind
• ZocDoc

Local health departments, community clinics, or college clinics (for students) often offer low-cost or free herpes testing. 

Because HS is rare, it can be difficult to find a knowledgeable provider. When you meet a provider, ask if they have experience treating HS. Look for someone who listens and understands how HS affects you emotionally. It's okay to get a second opinion if you feel uncomfortable.

Here are some resources to help you find HS specialists:

• American Academy of Dermatology Association - US 
• Hidradenitis Suppurativa (HS) Specialty Clinics
• HS Connects - Dermatologists by State
• National Health Service - UK 

A Quick Review 

HS causes painful bumps in areas where skin rubs together. It's not contagious, and though experts aren't entirely sure what causes it, it might run in families.

Herpes is an infectious and contagious virus that creates blisters, often around the mouth (cold sores) or genitals. It spreads through skin-to-skin contact or sex.

There's no cure for either condition, but treatments can help reduce outbreak frequency and severity.