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Acne Inversa of the Face : Hidradenitis Suppurativa (HS): Symptoms and Treatment

  • Hidradenitis suppurativa (HS) or Acne Inversa is a chronic skin condition that causes small painful bumps to form under the skin. 
  • The bumps are often filled with pus and can bleed or become crusty. 
  • HS usually affects the armpits groin and buttocks but it can occur anywhere on the body where there are sweat glands.

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Symptoms of Acne Inversa of the face

  • Hidradenitis suppurativa on the face may accompany HS in more typical locations such as the armpits or groin or, in rare cases, it may be the only sign of HS.
  • If you already have HS, you may know best how an HS nodule or abscess develops. However, for those who have nodules only on the face, it is easy to confuse it with acne in its early stages.
  • HS can be confused with acne because the bumps and boils that form with HS often look like pimples. Although HS is also known as reverse acne, it is not the same as the most common type of acne, acne vulgaris. However, the two conditions can occur together.
  • Although acne and HS both involve inflammation and may appear similar, they are markedly different in their genetics and risk factors.

What to expect for this disease

  • HS abscesses that appear on the face can look similar to HS abscesses that typically occur on the body. 
  • However, since they often look like acne when on the face, it's easy to misdiagnose them.

Specific Symptoms

Common face-specific symptoms include:

  • Pitted blackheads that may appear together
  • Bumps or lumps in the skin
  • Tunnels or pathways that connect bumps that may contain pus
  • Slow-healing abscess or erupting pimples
  • Rope-like scars that are interconnected

Other conditions that look like HS on the face

  • HS on the face can often be confused with other conditions. If your only symptoms of HS are on the face, it may take longer for a healthcare professional to rule out these other conditions.
  • Other conditions that appear on the face that can be confused with HS include:

Acne vulgaris

  • Acne vulgaris is a typical acne that usually occurs in adolescence. It's not uncommon for this to happen alongside HS.

Cysts on the face

  • Cysts on the face also occur at the hair follicle, but can be resolved with treatment and removal.


  • Folliculitis can look like acne or HS, but upon further examination, a healthcare professional can distinguish it from other diseases based on how the hair follicle is affected and the type of bacteria present in this infection.

What Causes Acne Inversa of the Face

  • Although no one knows the exact cause of HS, certain factors increase the likelihood that you will get it. These may include:
    • Genetic
    • Smoking
    • To be overweight
    • Lithium therapy 
    • Shaving areas most likely to develop HS, such as the armpits and groin, which are associated with early onset of the disease

Can acne inversa be cured?

  • Treatments for HS on the face are identical to those utilized on other parts of the body where the disease manifests itself. 
  • These treatments aid in the slowing of the disease's course, reducing inflammation, and preventing or reducing scarring.

Dermabrasion and microdermabrasion

  • Dermabrasion and microdermabrasion are minimally invasive techniques for scar reduction that surgically remove the top layers of skin.

Chemical peels

  • Chemical peels, such as resorcinol, have been shown to reduce discomfort, edema, and the size of HS nodules in people with early-stage HS. 


  • Scars can be less noticeable with microneedling. Thousands of mini-pricks are caused by rolling a barrel of tiny needles over the skin. This treatment initiates a collagen-producing healing process (a protein). The scar's skin is replaced with collagen, which improves its appearance.

Laser Resurfacing

  • Laser resurfacing, which involves directing focused light at the skin, has shown potential in improving the color and texture of HS scars.

Surgical Excision

  • If the scar becomes infected, covers a wide region, or develops tunnels under the skin, surgical excision of Acne Inversa scars may be required. 
  • Surgery can also help to restore a person's appearance.

Scarring injections

  • Scarring injections such as cortisone or collagen can soften and shrink scars or promote the growth of new skin.


  • Medications may also be prescribed to reduce disease flare-ups, prevent scarring, and calm inflammation around HS nodules. These may include:


  • Antibiotics, such as tetracyclines, clindamycin and erythromycin can be used. Although HS is not an infectious disease, antibiotics have been shown to alter the microbiome (mixture of bacteria present) of the skin to help relieve HS symptoms.


  • Corticosteroids are used to reduce inflammation and dampen the immune response.


  • Retinoids (derivatives of vitamin A) are used on the skin to fight inflammation.


  • Metformin helps regulate blood sugar because insulin resistance (the body doesn't use insulin well to keep blood sugar levels constant) is associated with HS.


  • Methotrexate, a chemotherapy drug, is used to regulate the immune system


  • Biotherapy, such as Humira (adalimumab) and Enbrel (etanercept), also act on the immune system to control the body inflammatory response.


  • Hidradenitis suppurativa (HS) most commonly affects sweat glands and hair follicles, although it can also affect the face. HS on the face can be mistaken for a variety of different disorders that can occur at the same time.
  • Although the specific cause of HS is unknown, a variety of variables contribute to its worsening. Lifestyle adjustments, such as stopping smoking and avoiding things that irritate the nodules, as well as pharmaceuticals, are used to treat HS on the face. Dermabrasion and laser therapy are two other cosmetic treatments that may be beneficial.


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