Adapalene
Strong evidenceThe strongest thing you can buy without a prescription, and the best first move for most acne. It unclogs pores before they inflame, which is why it prevents spots rather than treating them.
Acne vs Hidradenitis Suppurativa
Hidradenitis suppurativa is a long-term inflammatory condition that causes painful lumps, abscesses and tunnels in the armpits, groin and under the breasts. It is not an infection and it is not caused by poor hygiene, and treating it early is what prevents the scarring.
Key differences
The same eight facts on every condition comparison.
Usual age
Teens to mid-20s
Teens to 40
Where
Face, chest, back
Armpits, groin, under breasts, buttocks
Main sign
Clogged pores and spots
Painful lumps that drain and tunnel
Itch or pain
Spots can be sore
Painful
Contagious
No
No
Long term
Controlled; often outgrown
Long-term; flares
Scars
Can scar
Often scars
Who gets it
Most teens; some adults
Women, smokers, family history
What is it?
Acne
Hidradenitis Suppurativa
What is it?
It starts in the follicle.
Acne affects the hair follicle and its oil gland.
Spots take several forms.
Plugs form blackheads or whiteheads; inflammation forms pimples and deeper lumps.
It is not about dirt.
Bacteria are only one part of the process.
Tests are rarely needed.
An unusual pattern or hormonal symptoms may call for assessment.
Overview
Oil and dead skin cells block hair follicles. This can cause blackheads, whiteheads, pimples, or deeper painful lumps.
It is a chronic inflammatory disease.
It causes recurrent painful nodules, draining tunnels and scars, usually in skin folds.
It is not contagious.
It is not caused by poor hygiene.
Early recognition matters.
Prompt diagnosis can reduce treatment delays and limit tissue damage.
The whole picture guides care.
Pain, drainage, activity limits and mood all shape the treatment plan.
What it looks like
Acne
Comedonal acne Mostly blackheads and whiteheads.
Inflammatory acne Red papules and pustules.
Nodulocystic acne Deep painful lumps that can scar.
Hormonal acne Breakouts along the jaw and chin.
Body acne On the chest, back and shoulders.
Hidradenitis Suppurativa
Hurley stage I Single lumps, no tunnels or scars.
Hurley stage II Recurring lumps with tunnels and scars.
Hurley stage III Widespread tunnels and scarring.
Skin tones
Diagram
In the skin
Oil and shed skin cells can block a hair follicle, changing the environment inside the pore. Bacterial activity and the immune response contribute to inflammation, swelling and tender spots.
Blocked hair follicles can widen and rupture, releasing contents into nearby tissue and triggering painful inflammation. Repeated episodes may lead to tunnels beneath the skin and scarring.
Where it shows up
Face, chest and upper back
Armpits and other skin folds
When it usually starts
010203040506070+
Acne. Acne Often in teens Often begins in the teen years; acne can continue or first appear in adulthood.
Hidradenitis Suppurativa. Usually begins after puberty, often in the teens or younger adult years.
Causes and triggers
Causes
Acne forms when oil and dead skin cells clog pores, acne bacteria grow inside them, and inflammation follows. Hormones that increase oil play a central role.
Oil and dead skin cells block hair follicles. Bacteria within the follicles and inflammation contribute to pimples and deeper spots. Hormonal changes can increase oil production.
Hidradenitis suppurativa starts with blocked hair follicles in skin folds. The immune system then overreacts, causing deep, painful lumps.
Family tendency
Acne often runs in families. A parent with severe acne raises the chance of severe acne.
Acne can run in families. A close relative with deep, painful acne increases the chance of developing that pattern.
About 1 in 3 people with it have a relative with it.
Risk factors
Teen years, Family history, Polycystic ovary syndrome, Oily skin, Puberty, Hormonal changes
Obesity, Smoking, Female sex, Family history
Trigger
● Acne
● Hidradenitis Suppurativa
Hormone changes around periods
Well established
Not listed
Heavy, pore-clogging products
Strong link
Not listed
Some medicines like steroids
Strong link
Not listed
Friction from masks, helmets or phones
Strong link
Not listed
High-sugar and dairy-heavy diets
Possible
Not listed
Stress
Possible
Not listed
Hormonal changes
Common trigger
Not listed
Pore-clogging products
Common trigger
Not listed
Sun exposure
Not a typical trigger
Not listed
Heat and sweating
Can contribute
Not listed
Alcohol
Not a typical trigger
Not listed
Spicy foods
Not a typical trigger
Not listed
Harsh skin care
Can contribute
Not listed
Friction and tight clothing
Can contribute
Strong link
Shaving or waxing
Not a typical trigger
Not listed
Poorly maintained hot tubs
Not a typical trigger
Not listed
Prolonged antibiotic use
Not a typical trigger
Not listed
Heat and sweat
Not listed
Strong link
Hormone changes
Not listed
Strong link
Smoking
Not listed
Well established
Daily Care
Acne
Hidradenitis Suppurativa
Daily care
Habits that help
- Strip the routine back
Use a gentle cleanser, moisturizer and sunscreen without unnecessary product layers. - Cut back on sugar and refined carbs
Helps a little, mostly in oily, hormonal acne. - Wear sunscreen daily
Stops dark marks from deepening.
Avoid
- Avoid: Picking and squeezing
The biggest cause of avoidable scars. - Avoid: Scrubbing and over-washing
Strips the barrier and pushes you off treatment. - Avoid: Adding more products
Avoid adding several irritating products at the same time. - Avoid: Heavy oil-based hair products
Cause stubborn small bumps along the hairline. - Avoid: Friction and trapped sweat
Straps and collars press oil into pores. - Avoid: Heat and humidity
Swell the pore lining and trap what is behind it. - Avoid: High-glycemic diet
Sugar and refined carbs raise the hormones driving oil. - Avoid: Skim milk and whey protein
Linked to acne more than other dairy, though weakly. - Avoid: Stress
Raises the hormones that worsen acne you already have. - Avoid: Stopping treatment once it works
Acne usually returns within two to three months.
Habits that help
- Stopping smoking
The highest-value change available. - Warm compresses
Ease pain and help a lump come to a head. - Loose breathable clothing
Cotton, no waistband over a fold, damp clothes changed promptly. - Weight loss where it applies
Less friction, less background inflammation. - Absorbent dressings
Not treatment, but the right dressing changes daily life. - Topical clindamycin
An antibiotic lotion for mild disease, with benzoyl peroxide. - Clindamycin with rifampicin
Two antibiotics together for moderate disease. - Hormonal treatment
Spironolactone or a combined pill, where flares track the cycle. - Metformin
Added where there is insulin resistance or polycystic ovary syndrome. - Track flares around your menstrual cycle
Many people flare reliably the week before a period. - Discuss sustainable weight goals where relevant; avoid blame or crash dieting
More friction, more affected folds, more background inflammation.
Avoid
- Avoid: Smoking
The clearest avoidable factor, and it acts on the disease itself. - Avoid: Squeezing or lancing at home
Pushes the contents sideways and helps a tunnel form. - Avoid: Friction and tight clothing
Waistbands, seams, tight jeans and underwire set flares off. - Avoid: Shaving and waxing the area
Both irritate the follicle and cause ingrowns. - Avoid: Heat and trapped sweat
Hot weather, and damp gym gear left on. - Avoid: Deodorants and antiperspirants
Fragrance or alcohol on inflamed skin irritates. - Avoid: Stress and poor sleep
Both raise background inflammation. - Avoid: Waiting it out
Every untreated year is more chance of tunnels. - Avoid: Stopping treatment when it works
Control is maintenance. Flares return within weeks to months.
Treatment differences
Evidence labels come from each condition’s own treatment list.
Treatment
● Acne
● Hidradenitis Suppurativa
Filter by type
Over-the-counter
Benzoyl Peroxide
Strong evidenceKills the bacteria involved in inflamed spots, and is the one thing that stops acne bacteria becoming resistant to antibiotics. Lower strengths work about as well as higher ones and sting less. It bleaches towels and pillowcases.
Azelaic Acid
Moderate evidenceWorks on the spot and the mark it leaves at the same time, which makes it useful on deeper skin tones. It is also one of the few acne treatments considered safe in pregnancy.
Salicylic Acid
Moderate evidenceGets inside the pore and loosens the plug, so it suits blackheads and whiteheads more than deep spots. Gentler than a retinoid, and weaker than one.
Niacinamide
Limited evidenceSold heavily for acne, and the evidence for clearing spots is thin. It is genuinely useful for the marks left behind and for tolerating stronger actives - just not as the treatment itself.
Sulfur
Limited evidenceAn old treatment, usually a mask or a spot dab, that dries the surface of a spot and mildly loosens plugs. It is gentle enough for skin that cannot tolerate benzoyl peroxide or a retinoid. It smells, and it is weaker than everything above it on this list.
Tea Tree Oil
Limited evidenceA 5 percent gel reduces inflamed spots in small studies, more slowly than benzoyl peroxide does. Neat oil straight from the bottle is a common cause of an itchy rash, so buy it already diluted. It is a reasonable extra rather than something to build a routine on.
Benzoyl Peroxide wash
Limited evidenceAn antiseptic wash used two or three times a week on the affected folds, lathered and rinsed rather than left on. It lowers the bacteria on the skin and is often paired with clindamycin lotion to stop resistance building. It will not stop lumps forming on its own, and it bleaches towels and dark clothing.
Ibuprofen and acetaminophen
Limited evidenceFor flare pain, which is at its worst in the day or two before a lump bursts or is drained. Taken regularly through a flare they work better than taken only at the peak. If they are not touching the pain, that is a reason to be seen rather than to take more, because a steroid injection settles a single lump far faster.
Chlorhexidine wash
Limited evidenceAn alternative antiseptic wash for the folds if benzoyl peroxide is too drying or bleaches too much. Same use: lather, rinse, a few times a week. It reduces the odor some people find hardest to live with. It does nothing about the inflammation underneath, so it is a support rather than a treatment.
Zinc supplements
Limited evidenceOral zinc is often suggested online for this condition. The studies behind it are small and uncontrolled, and it has not been shown to change flares in any reliable way. High doses upset the stomach and interfere with copper absorption over time. Worth mentioning to your doctor rather than starting alone.
Absorbent dressings
ListedNot a treatment, but the thing that changes daily life most for anyone with a draining lesion. A soft absorbent pad held with tubular netting or a stretchy vest handles the fluid without an adhesive that tears sore skin. A dermatology nurse can advise which dressing suits which site, and many are available on prescription.
Prescription topicals
Tretinoin
Strong evidenceThe most studied topical in acne. Stronger than adapalene and more irritating with it, so it is usually the step up rather than the starting point. Not used in pregnancy.
Aklief
Strong evidenceA newer retinoid, and the one specifically tested on chest and back acne rather than just the face. Useful when the trunk is the main problem. Expensive without coverage.
Clindamycin
Strong evidenceCalms inflamed spots, but should never be used on its own. Guidelines are explicit about this - alone it stops working within months as bacteria adapt, so it is always paired with benzoyl peroxide or a retinoid.
Tazarotene
Strong evidenceThe strongest of the prescription retinoids, and the step to take when tretinoin has stopped making a difference. It is particularly good on stubborn blackheads and whiteheads. It is also the most irritating of them, so it is usually started two or three nights a week. Not used in pregnancy.
Winlevi
Moderate evidenceBlocks the hormone signal that drives oil production, but only where you put it. It is the first hormonal option that works topically, and the only one that can be used by men as well as women.
Aczone
Moderate evidenceMild on the skin and tends to suit adult women with inflamed spots who cannot tolerate a retinoid. Applied at the same time as benzoyl peroxide it can temporarily stain skin orange, so space them apart.
Clindamycin
Moderate evidenceA twice-daily antibiotic lotion for mild disease, the one topical here with real trial evidence behind it. It reduces the number of lumps and abscesses, and in early disease works about as well as tetracycline tablets. It is nearly always paired with a benzoyl peroxide wash, because clindamycin used alone breeds resistant bacteria.
Resorcinol
Limited evidenceResorcinol 15% cream. A peeling cream dabbed on a building lump to help it open and settle faster, made up by a compounding pharmacy. Some people find it shortens a flare noticeably. It stings, it can leave a temporary dark stain on deeper skin tones, and it only goes on the lump itself, not across the whole fold.
Prescription pills
Doxycycline
Strong evidenceBrings widespread inflamed acne down quickly, and is meant to be used for three to four months, not indefinitely. Always alongside a topical, which is what carries on once the tablets stop.
Accutane
Strong evidenceThe only acne treatment that often produces lasting clearance after the course ends. What it costs you is months of dry lips and skin, blood tests, and strict pregnancy prevention. For acne that scars, that trade is usually worth making early rather than late.
Spironolactone
Moderate evidenceFor the pattern rather than the individual spot - deep jawline acne in adult women that flares with the cycle. It works slowly, over three to six months, and can be continued long term. Not used in pregnancy.
Birth Control Pills
Moderate evidenceLowers the hormone signal driving oil production across the whole body, so it suits acne on the chest and back as well as the face. Takes about three months to show, and carries a small clot risk that needs weighing up.
Minocycline
Moderate evidenceAnother tetracycline antibiotic for widespread inflamed acne, used the same way as doxycycline: three to four months, always alongside a topical. It is usually kept as the second choice, because it carries rarer but more serious side effects, including a blue-gray skin discoloration with long use.
Seysara
Moderate evidenceA narrow-spectrum antibiotic designed specifically for acne, so it disturbs gut bacteria less than doxycycline. One tablet a day, still meant for three to four months and still alongside a topical. It works about as well rather than better, and it is considerably more expensive.
Doxycycline
Moderate evidenceA tetracycline antibiotic taken for two to three months, used here for its anti-inflammatory effect rather than to kill an infection. That is why the course is months rather than a week. It reduces flares for many people with mild to moderate disease, and it generally stops working once it is stopped. Take it with water and stay upright afterwards, and expect to burn more easily in the sun.
Accutane
Limited evidenceIsotretinoin transforms severe acne, so it is a fair question here. It works much less well for this condition, which starts in the follicle but is not driven by oil, and many people are no better on it. Acitretin, a related tablet, has slightly better results. Neither can be used in pregnancy.
Spironolactone
Limited evidenceA hormonal tablet that suits people whose flares track the menstrual cycle. The evidence is from clinics rather than large trials, but the response in the right person can be very good. It takes three to six months to judge, it raises potassium so blood tests are needed, and it must not be used in pregnancy.
Birth Control Pills
Limited evidenceA combined pill can reduce flares that cluster before periods, and it is often used alongside spironolactone rather than instead of it. Progesterone-only methods sometimes make the condition worse. Smoking matters here in two ways: it worsens the disease and it also rules out the combined pill for many people over 35.
Clindamycin with rifampicin
Moderate evidenceTwo antibiotics taken together for a set ten to twelve week course in moderate disease, usually when tetracyclines have not held. The combination works better than either alone. Rifampicin turns urine and tears orange, stains soft contact lenses, and interferes with several medicines including the contraceptive pill, so the doctor needs your full medicine list.
Metformin
Limited evidenceA diabetes tablet sometimes added where there is insulin resistance, polycystic ovary syndrome or metabolic syndrome alongside the skin disease. Small studies show fewer flares in that group. It is an add-on, not a main treatment, and it commonly upsets the stomach for the first few weeks.
Prednisone
Limited evidenceA short course of steroid tablets to break a severe flare while a longer-term treatment is being arranged. It works quickly. It is not a way to manage this condition, because flares return as the dose comes down and repeated courses cause weight gain, bone loss and blood sugar problems.
Injections
Cortisone Injection
Limited evidenceDeals with one stubborn painful lump, not the condition. It settles in a day or two and is the safe alternative to squeezing it. It does nothing to prevent the next one.
Cortisone Injection
Limited evidenceA small amount of steroid injected straight into a single painful lump, which usually settles it within a day or two. It is the fastest thing available for one bad flare and it avoids cutting. It treats that one lump only, and repeated injections in the same spot can thin the skin, so it is not a plan on its own.
Humira
Strong evidenceThe first biologic licensed for this condition, given as a self-injection under the skin every week or two. It blocks one of the immune signals driving the disease and reduces lumps and abscesses in moderate to severe cases. It does not close existing tunnels. You are screened for tuberculosis and hepatitis first, and infections need reporting while you are on it.
Cosentyx
Strong evidenceA newer biologic injection that blocks a different immune signal, licensed for this condition after trials in moderate to severe disease. It is the usual next step when adalimumab has not worked or has stopped working. Like adalimumab, it treats the inflammation rather than the tunnels, so it is often combined with surgery.
Procedures
Comedone Extraction
Limited evidenceClears blackheads that are already there, quickly and visibly. It does not stop new ones forming, so it is an add-on to a retinoid rather than a substitute for one.
Chemical Peel
Limited evidenceModest benefit for clogged pores and a better one for the dark marks left behind. Needs repeat sessions, and the benefit fades if the daily treatment stops.
1726 nm Laser
Limited evidenceHeats the oil glands themselves, which is a genuinely different approach from everything else on this page. Trial results out to about six months are good, it works across skin tones, and it is expensive and rarely covered. Long-term data is still limited.
Photodynamic Therapy
Limited evidenceCan help stubborn inflamed acne, but the protocols vary widely between clinics, the downtime is real, and the evidence is not strong enough to put it ahead of the options above.
Blue Light Therapy
Limited evidenceBlue light kills acne bacteria at the surface, so a course can quiet mild inflamed spots for a while. The effect fades within weeks of stopping, and it does nothing for blackheads or deep lumps. In-clinic courses cost far more than a topical that would do more.
Deroofing
Moderate evidenceThe roof of a tunnel is removed under local anesthetic and the floor is left to heal open. The tunnel does not come back in that spot. It is small, done in clinic, and leaves a flatter result than cutting a wide block of skin out, which matters more on deeper skin tones. It treats the tunnels you have, not the disease, so medication usually continues.
Surgical Excision
Moderate evidenceWide excision. A whole affected area is removed surgically, for advanced disease where tunnels run right across an armpit or groin. Disease does not return in the removed area, though it can appear at the edges or in another fold. It is done in an operating theatre, healing takes weeks, and the area may need a skin graft or flap.
Laser Hair Removal
Moderate evidenceRemoving the hair removes the follicle that plugs, and several courses of treatment reduce flares in early disease. It works best on Hurley stage one and two, before tunnels form. On deeper skin tones the device matters: the long-pulsed Nd:YAG is the usual choice, and the wrong laser causes burns and pigment change. Ask which one the clinic will use.
Incision and Drainage
Limited evidenceIncision and drainage. Cutting a swollen abscess open relieves severe pressure and pain quickly, which is why it is done in emergency departments. It does not change the course of the condition and the lump usually refills in the same place within weeks. Repeated draining of the same spot encourages a tunnel to form, so it is a rescue measure rather than treatment.
Outlook
Long term
Acne is usually controlled rather than permanently cured. Treatment reduces new breakouts, but improvement takes time and maintenance may be needed. Deep or scarring acne deserves early assessment because existing scars may remain after the active spots settle.
It runs in flares and quiet periods, and follows a longer arc over years. Not everyone progresses. The toll is real — pain, drainage, dressings, clothes chosen around it, embarrassment about the smell — and rates of depression and anxiety are high, worth raising at an appointment.
Complications
Possible complications
- Dark marks
- Redness
- Scars
- Depression and anxiety
- Family conflict
- Social impact
More details
Dark marks
Flat brown or violet patches left where a spot was. They are not scars and they do fade, but it commonly takes 6 - 12 months, and sun exposure makes them last longer. These WILL FADE with time.
Redness
Flat pink or red marks left where a spot was, most often on lighter skin. Also not scars. They usually settle on their own, though it can take several months. These WILL FADE with time.
Scars
Permanent dents, pits or raised bumps left where inflammation broke down the skin's structure. Once formed, they can only be improved by procedures. These WILL NOT FADE with time.
Depression and anxiety
Acne can affect self-esteem, confidence and mental health. The link is consistent, and it does not track with how severe the acne looks to anyone else - which is itself a reason to treat it.
Family conflict
This is very common. Acne visits involving a teenager and a parent can sometimes be challenging, particularly when there is ongoing conflict about acne care.
Social impact
People may avoid photos, dating, social situations or activities because of their skin.
- Scarring and restricted movement
- Depression and anxiety
- Squamous Cell Carcinoma
More details
Scarring and restricted movement
Years of flares in the same fold leave thick, rope-like scars that pull the skin tight. In an armpit that can limit how far the arm lifts; in the groin it can make sitting or walking uncomfortable. Scars cannot be reversed with medication, so the way to avoid them is to get on proper treatment early. Surgery can release or remove a badly scarred area.
Depression and anxiety
Constant pain, drainage, dressings and the smell wear people down, and rates of depression and anxiety in this condition are high. It is a normal response to a hard illness, not a separate weakness. It is also rarely asked about, so it is worth raising yourself at an appointment. Getting the skin under control usually helps a great deal, and support for the mood side can be arranged at the same time.
Squamous Cell Carcinoma
A rare complication of very long-standing disease, usually after decades of tunnels and scarring on the buttocks or groin. A skin cancer can grow in the damaged skin. The warning sign is a lump, ulcer or growth that behaves differently from your usual flares and does not settle. Anything like that should be looked at and biopsied rather than treated as another flare.
When to get help
When to get help
Seek help for painful deep spots, scarring, persistent breakouts, or an uncertain diagnosis. Earlier treatment can reduce the chance of more scars.
Do not assume eye symptoms are part of acne. They need their own assessment.
Seek early assessment for recurring painful lumps, drainage or tunnels. Fever, spreading redness or severe pain needs prompt care.
Common questions
Acne:Does acne ever go away?
For most people it settles by the mid-twenties. About one in six women still has it into her 30s and 40s, and it can return after pregnancy, after stopping the pill, or with any hormone shift. Controlled rather than cured.
Acne:Does what I eat cause acne?
Less than the internet suggests. The evidence points at high-glycemic diets - sugar and refined carbohydrate - and, less consistently, at skim milk. Chocolate and greasy food never held up, and no diet replaces treating the skin.
Acne:Why does my skin get worse when I start a new treatment?
That is purging. Retinoids speed up clogs already forming under the surface, so weeks of spots arrive at once. It peaks around weeks two to six and settles by week eight. Still worsening past 10 to 12 weeks is irritation, not purging.
Acne:Is it ever okay to pop a spot?
No. Squeezing pushes the contents sideways into surrounding skin, turning a spot that would have gone in days into a mark that lasts months, or a scar that lasts forever. A large, painful lump can be injected in clinic instead, and settles in a day or two.
Acne:Do I need antibiotics?
Sometimes, but never alone and never for long. They go alongside benzoyl peroxide or a retinoid, usually for three to four months, then stop while the topical carries on. Alone or indefinitely, they stop working and drive resistance.
Acne:Is my acne hormonal?
Almost all acne is hormonal - hormones drive oil production. The label only matters if it changes treatment: deep spots along the jawline and lower face in an adult woman, flaring before periods, usually respond better to hormonal treatment than to antibiotics.
Hidradenitis Suppurativa:Is this contagious?
No. It cannot be passed through skin contact, towels, swimming pools or sex. It starts in your own hair follicles and is driven by your own immune system.
Hidradenitis Suppurativa:Why do antibiotics stop working?
They were never killing an infection. Tetracyclines are given for months here because they calm inflammation, and the effect fades when they stop. If antibiotics are not holding, move up to hormonal treatment or a biologic.
Hidradenitis Suppurativa:Will I need surgery?
Only if tunnels have formed, and not everyone reaches that stage. Medication treats inflammation but cannot close a tunnel, so once one exists a small procedure called deroofing is often the cleanest answer. It is done under local anesthetic and the tunnel does not return.
Hidradenitis Suppurativa:Does losing weight fix it?
It helps, and it does not fix it. Losing weight reduces friction, reduces affected folds and lowers background inflammation, and many notice fewer flares. But people of every size get this, and treating it as a weight problem is one reason people are sent away without proper treatment.
Hidradenitis Suppurativa:Can I still shave or have laser hair removal?
Shaving and waxing tend to provoke flares, so clipping is better day to day. Laser hair removal often reduces flares by removing the follicle and is worth considering, particularly in early disease. On deeper skin tones the device matters — ask which laser will be used.
Hidradenitis Suppurativa:Will it affect having children?
The condition does not affect fertility, but several treatments are not suitable in pregnancy, including some antibiotics and hormonal treatments. Many find it flares in pregnancy and improves afterwards, or the reverse. Plan ahead with the doctor managing your pregnancy, and never start or stop a medicine on your own.
Sources