The Difference Between Folliculitis and Hidradenitis Suppurativa | myHSteam (2022)

The Difference Between Folliculitis and Hidradenitis Suppurativa | myHSteam (1)

The symptoms of hidradenitis suppurativa (HS), also known as acne inversa, may appear similar to those of other conditions. Folliculitis, in particular, may sometimes be confused with HS. Both conditions cause swollen, fluid-filled lumps to appear on the skin. These lumps may be red and painful.

Despite their similarities, HS and folliculitis are distinct conditions with their own causes and treatments. Although the differences between folliculitis and HS should be clear to a doctor or dermatologist, it may help you to understand the differences between their symptoms, causes, and treatments.

What Is Folliculitis?

The Difference Between Folliculitis and Hidradenitis Suppurativa | myHSteam (2)

Folliculitis is a skin disease characterized by inflammation of a hair follicle. The hair follicle is a small space or opening around the root of a hair. Every hair on the human body has its own follicle. The inflammation seen in folliculitis can cause swelling and pain at the affected follicle, as well as the accumulation of white or yellowish pustules (fluid-filled bumps) that look similar to acne.

Some cases of folliculitis clear up with antibiotics or other treatments, and others last for a long time. Long-lasting or persistent folliculitis is called chronic folliculitis.

Are Folliculitis and Hidradenitis Suppurativa Related?

Although the relationship between the two conditions is not yet understood, many people diagnosed with HS also experience folliculitis. Folliculitis can occur in the same areas affected by HS (the apocrine-bearing areas, or areas that produce a high volume of sweat) or in other unrelated locations. HS usually appears under the arms, around the buttocks, and the inguinal folds. Folliculitis can occur additionally on the scalp, beard area, chest, and back.

(Video) Deroofing of sinus tracts in Hidradenitis Suppurativa for Healthcare Professionals

The Difference Between Folliculitis and Hidradenitis Suppurativa | myHSteam (3)

Some experts believe that HS is often misdiagnosed as folliculitis. Others state that a person can experience both conditions at the same time, at different times, or independently of one another. Some researchers argue that HS should be considered a type of folliculitis, noting that HS has more in common with folliculitis than with any of the other conditions it is often categorized under.

Although research has determined a statistical connection between folliculitis and HS, more study is necessary to understand the particulars of this relationship.

Symptoms of Folliculitis and Hidradenitis Suppurativa

Folliculitis and HS are characterized by bumps on the skin that may itch or burn. These bumps tend to form in areas with high concentrations of sweat glands and frequent skin-on-skin friction, like in the armpits or underarms, inner thighs, or the groin (folliculitis can also occur in other areas of the body). Both folliculitis and HS may also result in infections that require medical treatment.

In its early stages, folliculitis usually appears as a group of tiny bumps on the skin. These bumps may be red or filled with white or yellowish fluid, giving the appearance of whiteheads. If left untreated, a major infection can develop and form a pus-filled bump called a boil or furuncle. If several boils merge together, they form a carbuncle or abscess.

HS, on the other hand, may first appear like blackheads (bumps with dark-colored centers) or as pea-sized lumps under the skin. These bumps don’t go away for weeks and may be painful and itchy. Over time, these lumps may get bigger and ooze fluid and pus. If left untreated, these bumps may form tunnels under the skin (sinus tracts) that continually ooze blood and pus and can lead to extensive scarring.

Causes and Risk Factors of Folliculitis and Hidradenitis Suppurativa

Despite the overlap in some of their symptoms, folliculitis and HS have distinct causes and risk factors.

(Video) HIDRADENITIS SUPPURATIVA: Q&A WITH DERMATOLOGIST DR DRAY

Folliculitis is usually caused by infection with staphylococcus bacteria (known commonly as a staph infection). This condition can also be caused by other bacterial infections, yeast, viruses, fungal infections, and more. Occasionally, an inflamed hair follicle can trigger folliculitis, but this is less common.

Risk factors for folliculitis include having a compromised immune system, being exposed to bacteria or other substances that can cause the condition, taking certain medications, and having acne or dermatitis.

HS occurs when the apocrine glands become clogged, often when certain types of cells grow too quickly and prevent the body’s naturally occurring oils from escaping. Experts aren’t sure exactly why this growth occurs, although ongoing research is attempting to determine the exact cause. We do know that HS does not occur due to uncleanliness or infection and is most likely an inflammatory process.

Those at risk of developing HS include people with a family history of the condition, people who smoke, those who are overweight or obese, and those who have been diagnosed with certain other conditions (including arthritis, diabetes, inflammatory bowel disease, and metabolic syndrome). Women in their 20s and 30s are at the highest risk of HS. Being African American may also be a risk factor, although studies are ongoing.

Diagnosing Folliculitis and Hidradenitis Suppurativa

The diagnostic process for folliculitis and HS is often similar, particularly at the onset of the skin condition. If your health care provider suspects you have folliculitis or HS, your doctor or dermatologist will take a comprehensive medical history, focusing specifically on your skin diagnosis (or your family’s skin diagnoses) and other diagnoses often related to HS.

A doctor will then perform a thorough examination of the affected areas of skin, noting where your breakouts are located. They will likely ask when your symptoms first appeared, how long the symptoms usually last or have lasted, and whether the symptoms are constant or tend to disappear then reappear.

(Video) Folliculitis, Causes, Signs and Symptoms, Diagnosis and Treatment.

To aid in the diagnostic process, a doctor may also perform a biopsy (microscopic examination of the affected skin cells). If you have sores, cysts, nodules, pimples, or lesions that are draining fluid or pus, the doctor may take a sample of this fluid to test for any bacteria growing in the area. Finally, your doctor may ask for a blood test, especially if they suspect HS. Certain markers in your blood can indicate that HS is the correct diagnosis rather than folliculitis.

Some doctors prefer to try certain treatments and evaluate how well they work before making a conclusive diagnosis. They may not diagnose HS until treatments for other skin conditions, including folliculitis, have proven ineffective.

Treating and Managing Folliculitis and Hidradenitis Suppurativa

Certain treatment options for folliculitis and HS overlap. Both may be treated with oral antibiotics, topical cream-based antibiotics, and antibacterial soaps. These treatments may clear up the infection once and for all in those with folliculitis. Antibiotics are used to treat the inflammation that has escalated into an infection in those with HS. A low-dose antibiotic may be taken for long periods of time.

Both conditions may also be treated with creams or oral medications designed to fight inflammation, including nonsteroidal anti-inflammatory drugs and corticosteroids.

After that, treatments tend to vary. Folliculitis caused by a fungal infection can be treated with antifungal pills or creams. Minor surgery may be necessary to fully remove the infection in large carbuncles. Recurrent folliculitis may call for laser hair removal.

People with HS may require treatment with biologic medications (such as adalimumab), which are designed to lower the body’s inflammation levels. Other biologic medications are being investigated for HS, as the pathophysiology indicates that some pathway in the immune system leads to HS. HS related to hormones may be controlled by taking hormonal birth control, and retinoids have also proven helpful. In some cases, abscesses may need to be drained, or HS lesions may be treated with a laser to clear them of accumulated fluids. HS can also be treated surgically, removing the affected glands usually as a last resort.

(Video) MY Treatment Journey w/ Hidradenitis Suppurativa and Folliculitis Part 1

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References

FAQs

What is the difference between HS and folliculitis? ›

It may feel itchy or painful, or you may not feel anything. Early HS is more likely to be a lump under the skin or small, tender bumps. Folliculitis can happen anywhere you have hair follicles, which is most of your body. It often goes away on its own within a few weeks.

Can hidradenitis suppurativa be mistaken for folliculitis? ›

The HS bumps are often mistaken for pimples, boils, or folliculitis. You can recognize an HS breakout because it typically causes bumps on both sides of your body that tend to return in specific locations, such as your armpits and groin.

Can folliculitis cause HS? ›

Acute cases occur for a short time, while chronic cases are long lasting. Folliculitis happens frequently in people with Hidradenitis Suppurativa, both in areas where one is prone to develop HS and in other areas. It is unknown if there is a common cause. Learn more about folliculitis on WebMD.

What is mistaken for folliculitis? ›

The types of psoriasis that can resemble folliculitis include : Plaque psoriasis, which causes dry, red patches on the skin. The patches may be raised, itchy, and painful. Guttate psoriasis, which produces small, scaling lesions on the skin.

What can be mistaken for hidradenitis suppurativa? ›

Mistaken as a boil, infection or folliculitis, misdiagnosis in the early stages of Hidradenitis suppurativa leads to delays in diagnosis and treatment.

What triggers hidradenitis suppurativa? ›

What causes hidradenitis suppurativa? The exact cause of hidradenitis suppurativa is unknown, but the lumps develop as a result of blocked hair follicles. Smoking and obesity are both strongly associated with hidradenitis suppurativa, and if you're obese and/or smoke it will make your symptoms worse.

What does deep folliculitis look like? ›

In most cases, the main symptom of folliculitis is red bumps that look like pimples on your skin. These could also look like they're white-filled bumps or they could be filled with pus (pustules). Folliculitis can feel itchy and uncomfortable. Many people feel the need to scratch when they have folliculitis.

How do you get rid of bacterial folliculitis? ›

For mild infection caused by bacteria, your health care provider may prescribe an antibiotic lotion or gel. Infection-fighting pills (oral antibiotics) aren't routinely used for folliculitis, but you may need them for a severe or repeat infection. Creams, shampoos or pills to fight fungal infections.

How long do folliculitis bumps last? ›

The rash appears as small red bumps or pus bumps that can itch or be mildly painful. Folliculitis is common on the buttocks, arms and legs - especially the thighs. Most improve in 7 to 10 days.

What happens if hidradenitis suppurativa goes untreated? ›

Hidradenitis suppurativa is an uncommon skin condition that starts out as pimple-like lesions on the skin. If left untreated, it can grow deeper into the tissue and over time can lead to painful fluid-filled lumps or thick scars.

What causes bacterial folliculitis? ›

Folliculitis is often caused when hair follicles are infected with bacteria, commonly Staphylococcus aureus (staph). It may also be caused by viruses, fungi, parasites, medications or physical injury. Sometimes the cause isn't known.

Is HS an autoimmune disease? ›

With current knowledge, HS is considered more of an auto-inflammatory illness. Officially and technically, it has not been classified as an autoimmune disease but patients and doctors alike will commonly use the “autoimmune” term as shorthand, causing confusion and leading to debate between the two.

What is the best antibiotic for folliculitis? ›

What is the best medication for folliculitis?
Best medication for folliculitis
Centany (mupirocin)AntibioticTopical
Zovirax (acyclovirAntiviralTopical
Elimite (permethrin)AntiparasiticTopical
AccutaneRetinoidOral
3 more rows
17 Nov 2021

What antibiotic treats folliculitis? ›

Folliculitis looks like acne pimples or non-healing, crusty sores. An acute eruption or one present for only a short time is usually due to Staph bacteria (impetigo of Bockhart). This is treated with oral cephalexin, dicloxacillin or similar oral antibiotic. Topical antibiotics creams or lotions can also be used.

What vitamin deficiency can cause folliculitis? ›

Severe vitamin A and C deficiency may cause folliculitis. [1] In vitamin A deficiency the skin shows follicular hyperkeratosis, dryness and generalised wrinkling. [11] It requires about 2 months of vitamin C deprivation to produce mucocutaneous signs, including perifollicular petechiae and follicular hyperkeratosis.

Who is prone to hidradenitis suppurativa? ›

The risk of hidradenitis suppurativa is higher for people in their 20s and 30s. Sex. Females are more likely to develop hidradenitis suppurativa than are males. Race.

What do HS bumps look like? ›

Tender, deep nodule(s) appears

The first sign of HS is often a painful spot that looks like a deep pimple, acne cyst, or boil. This spot often appears on an armpit (as shown here) or in the groin area. Some people develop a spot on their buttocks or inner thigh.

How quickly does hidradenitis suppurativa progress? ›

HS Damage May Begin Early and Progress Over Time

Assessing sinus tract involvement, scar tissue formation, and psychosocial implications are important aspects of determining disease severity. 52% of HS patients experienced disease progression in 1 or more regions within 2 years in the UNITE registry (N=318).

What are the 4 stages of HS? ›

HS is divided into three stages, based on how severe it is, called Hurley stages.
  • Hurley stage I: A single bump with no sinus tracts.
  • Hurley stage II: More than one bump but little tunneling.
  • Hurley stage III: Multiple bumps with a lot of sinus tracts and scars, involving an entire area of your body.
2 Oct 2020

What is inside hidradenitis suppurativa? ›

What was known? Hidradenitis suppurativa is a chronic, inflammatory disease involving the deep part of apocrine glands. It is characterized by tender subcutaneous nodules.

Is hidradenitis suppurativa a STD? ›

1. It's not an STD. HS breakouts can occur on your inner thighs near your genitals. This may cause some people to think HS is an STD or another contagious disease, but that's not the case.

Why is my folliculitis not going away? ›

Chronic folliculitis can be more difficult to treat. Antibiotics and other medications may not clear up chronic cases. If other treatment options fail, your doctor may recommend laser hair removal. During treatment, you should refrain from removing hair by plucking, waxing, or shaving.

What is herpetic folliculitis? ›

BACKGROUND Herpes folliculitis is a rare manifestation of herpes virus infection and it is often misdiagnosed. Diagnostic criteria are not well established, only 24 patients being reported in the literature.

Why does my folliculitis keep coming back? ›

Folliculitis usually occurs at sites where hair follicles are damaged by friction or shaving, or where there is blockage of the follicle. Excessive sweating (hyperhidrosis) due to overactivity of the sweat glands can be another cause. Sometimes, using a steroid cream on the face can trigger a bout of folliculitis.

What virus can cause folliculitis? ›

Types of folliculitis
  • Herpes simplex virus, the virus that causes cold sores, can cause folliculitis. ...
  • Drug-induced folliculitis often resembles acne (acne vulgaris). ...
  • Staphylococcal folliculitis is one of the more common types of folliculitis. ...
  • Fungus or yeast can also cause folliculitis.

How do I know if my folliculitis is fungal or bacterial? ›

Diagnosis of folliculitis

They may take a swab of the infected skin to test for which bacteria or fungus is the cause of the folliculitis. In rare cases, a doctor may order a skin biopsy to exclude the possibility of other causes.

How do you calm folliculitis? ›

Use anti-itching lotion

Over-the-counter anti-itching lotions and creams can help soothe folliculitis symptoms. They contain hydrocortisone, a kind of steroid medication that helps bring down itching, swelling, and redness. Apply the steroid cream or lotion thinly over the skin area. Wash your hands after using it.

Does folliculitis go away permanently? ›

Most cases of hair follicle infection get cured within a few weeks. So, stop shaving and protect your skin until the infection gets cured. For recurrent or severe folliculitis, the doctor may prescribe you to use antibiotic cream, gel, lotion, or even oral antibiotics.

What does folliculitis look like on pubic area? ›

Folliculitis looks like a mosquito bite or raised bump. Vaginal folliculitis caused by ingrown hairs may look like a small splinter under the skin or a raised bump with a dark spot or line (this is the trapped hair).

Should you exfoliate folliculitis? ›

Use a chemical exfoliant

Since this can increase your risk of folliculitis or worsen an existing case, using a chemical exfoliant to unclog your pores can help. Jaliman recommends using a salicylic acid or glycolic acid toner, which you can find as ingredients in many OTC skin care products.

Is HS linked to lupus? ›

A US cohort study showed a greater likelihood of developing certain connective tissue diseases like morphoea or systemic lupus erythematosus (SLE) in patients already suffering from hidradenitis suppurativa (HS) [1,2].

Does HS shorten life span? ›

HS is frequently associated with both spondyloarthritis and metabolic alterations, which increase the risk of cardiovascular disease and reduces life expectancy, the authors said.

What is the latest treatment for hidradenitis suppurativa? ›

Adalimumab is the only currently FDA-approved systemic medication for the treatment of HS.

Is folliculitis caused by poor hygiene? ›

Folliculitis is an inflammatory condition affecting hair follicles. It appears as a small red tender bump occasionally surmounted with dot of pus surrounding a hair. It is generally caused by an excess of bacteria, and poor hygiene, even for a short time.

What are the different types of folliculitis? ›

Fungal Folliculitis
  • Dermatophyte folliculitis. This form of the condition is caused by one of three types of fungus, namely the Epidermophyton, Microsporum or Trichophyton species. ...
  • Malassezia (Pityrosporum) folliculitis. Many of the Malassezia species cause folliculitis. ...
  • Candida folliculitis. ...
  • Herpes folliculitis.

Can you pop folliculitis? ›

Resist the temptation to squeeze or pop a folliculitis boil. While you might manage to express the pus and other infected fluid, you also run the risk of pushing those toxins more deeply into the skin, to the point that they may enter your bloodstream. Instead, let your dermatologist diagnose and treat the problem.

Does hidradenitis suppurativa make you tired? ›

Fatigue is common in people with HS. A 2010 study found that 40% of patients who took part reported clinical fatigue. Hidradenitis Suppurativa and fatigue unfortunately often go hand in hand.

Does exfoliating help hidradenitis suppurativa? ›

3. Don't scrub your skin. “Hidradenitis suppurativa is not caused by poor hygiene,” says Fernandez, so excessive cleansing is unlikely to be helpful. “[Scrubbing] is one of the worst things to do, because we think trauma can precipitate flares,” he adds.

Does hidradenitis suppurativa get worse with age? ›

Will it get worse? HS is called a progressive disease. That means it often gets worse over time.

Does diet affect folliculitis? ›

Our results suggest that an excessive intake of dietary fatty acids predisposes the skin to development of neutrophilic folliculitis. This occurs by induction of follicular hyperkeratinization and activation of follicular keratinocytes, which may be a direct consequence of the altered amount of fatty acids in the skin.

Does hydrogen peroxide help folliculitis? ›

Hydrogen Peroxide

It works just as well for folliculitis. The chemical mix will immediately kill off bacteria and fungus, and the excess can be wiped off with disposable towels. You can repeat applications of hydrogen peroxide.

How do I get rid of folliculitis in my pubic area? ›

Mild folliculitis might go away without any treatment. To help yourself heal and ease symptoms, you can: Clean the infected area: Wash twice a day with warm water and antibacterial soap. Be sure to use a fresh cloth and towel each time.

How do dermatologists treat folliculitis? ›

With this condition, the best course of treatment is antifungal drugs. Topical drugs and ointments like econazole and clotrimazole are often prescribed for a variety of fungal infections. These drugs, applied to malassezia folliculitis, can eliminate the fungus responsible for the irritation, clearing your symptoms.

What medications cause folliculitis? ›

Which drugs cause follicular eruptions?
  • Antibiotics (isoniazid, rifampicin and tetracyclines)
  • Steroids (adrenocorticotropic hormone [ACTH], androgens, systemic corticosteroids)
  • Hormones (oral contraceptives)
  • Halogens (iodides and bromides)
  • Immunosuppressants (azathioprine, ciclosporin, sirolimus)
  • Lithium.
  • Anticonvulsants.

Does vinegar help folliculitis? ›

MEASURES YOU CAN TAKE TO HELP TREAT YOUR FOLLICULITIS:

1. A holistic treatment may include soaking the affected area in a tub of diluted white vinegar (1 part vinegar to 4 parts of water) or soaking in a bathtub with very diluted Clorox bleach (1/4 cup of Clorox bleach in a bathtub of water).

What foods to avoid if you have folliculitis? ›

You can increase your intake of omega-3 fatty acids by eating more wild Alaskan salmon, sardines, fortified eggs, freshly ground flax seeds or walnuts. You can also take a fish oil supplement. You might also try hypnotherapy, which can be very effective for skin conditions.

Which vitamin is good for folliculitis? ›

Abstract. A type of acne induced by vitamin B-12 deserves a special place among acneiform eruptions. The eruption is monomorphic and of a particular type. It consists of voluminous folliculitis lesions which develop acutely after the first injections of vitamin B-12 and disappear rapidly when treatment is discontinued.

Can losing weight help folliculitis? ›

It doesn't take much weight loss to make a difference. Studies show that losing just 10% of your total weight can start to clear up your bumps.

What does folliculitis look like? ›

Folliculitis is a common skin condition that happens when hair follicles become inflamed. It's often caused by an infection with bacteria. At first it may look like small pimples around the tiny pockets from where each hair grows (hair follicles).

How do you get rid of bacterial folliculitis? ›

For mild infection caused by bacteria, your health care provider may prescribe an antibiotic lotion or gel. Infection-fighting pills (oral antibiotics) aren't routinely used for folliculitis, but you may need them for a severe or repeat infection. Creams, shampoos or pills to fight fungal infections.

What do HS bumps look like? ›

Hidradenitis suppurativa usually appears as one or more red, tender bumps that fill with pus. It most commonly occurs in the armpits (shown), groin, between the buttocks and under the breasts.

Can you pop HS bumps? ›

Don't squeeze or pop the lumps. Wash the area with antibacterial soap. Use antibiotic creams or ointment.

Why is my folliculitis not going away? ›

Chronic folliculitis can be more difficult to treat. Antibiotics and other medications may not clear up chronic cases. If other treatment options fail, your doctor may recommend laser hair removal. During treatment, you should refrain from removing hair by plucking, waxing, or shaving.

What is the best antibiotic to treat folliculitis? ›

What is the best medication for folliculitis?
Best medication for folliculitis
Centany (mupirocin)AntibioticTopical
Zovirax (acyclovirAntiviralTopical
Elimite (permethrin)AntiparasiticTopical
AccutaneRetinoidOral
3 more rows
17 Nov 2021

What antibiotics treat folliculitis? ›

Folliculitis looks like acne pimples or non-healing, crusty sores. An acute eruption or one present for only a short time is usually due to Staph bacteria (impetigo of Bockhart). This is treated with oral cephalexin, dicloxacillin or similar oral antibiotic. Topical antibiotics creams or lotions can also be used.

What vitamin deficiency can cause folliculitis? ›

Severe vitamin A and C deficiency may cause folliculitis. [1] In vitamin A deficiency the skin shows follicular hyperkeratosis, dryness and generalised wrinkling. [11] It requires about 2 months of vitamin C deprivation to produce mucocutaneous signs, including perifollicular petechiae and follicular hyperkeratosis.

What virus can cause folliculitis? ›

Types of folliculitis
  • Herpes simplex virus, the virus that causes cold sores, can cause folliculitis. ...
  • Drug-induced folliculitis often resembles acne (acne vulgaris). ...
  • Staphylococcal folliculitis is one of the more common types of folliculitis. ...
  • Fungus or yeast can also cause folliculitis.

What happens if folliculitis goes untreated? ›

Mild folliculitis will likely heal without scarring in a few days with basic self-care. More-serious or repeat infections may need prescription medicine. Left untreated, severe infections can cause permanent hair loss and scarring. Certain types of folliculitis are known as hot tub rash and barber's itch.

What are the 4 stages of HS? ›

HS is divided into three stages, based on how severe it is, called Hurley stages.
  • Hurley stage I: A single bump with no sinus tracts.
  • Hurley stage II: More than one bump but little tunneling.
  • Hurley stage III: Multiple bumps with a lot of sinus tracts and scars, involving an entire area of your body.
2 Oct 2020

How long do folliculitis bumps last? ›

The rash appears as small red bumps or pus bumps that can itch or be mildly painful. Folliculitis is common on the buttocks, arms and legs - especially the thighs. Most improve in 7 to 10 days.

Is HS considered a disability? ›

The Social Security Administration (SSA) recognizes hidradenitis suppurativa (HS) as a potentially disabling disease. For HS to be considered a disability, your symptoms must be severe enough to keep you out of work for 12 months or longer.

Does hydrogen peroxide help hidradenitis suppurativa? ›

According to our results, hydrogen peroxide with contrast-enhanced ultrasonography may represent a particularly useful preoperative diagnostic tool in hidradenitis suppurativa fistulas and pilonidal sinus, showing high diagnostic accuracy in the evaluation of primary tracts and secondary extension.

Is hidradenitis an autoimmune disease? ›

Observational, experimental, and therapeutic evidence supports the concept of hidradenitis suppurativa as a primarily inflammatory disorder, a disorder of autoimmunity, or both, in contrast to the current prevailing paradigm of primary follicular occlusion.

Videos

1. HOW TO REDUCE HIDRADENITIS SUPPURATIVA BOILS AND FLARE UPS | UPDATED 2021
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2. WHAT IS CAUSING MY FOLLICULITIS? Q&A WITH DERMATOLOGIST DR DRAY
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3. #shorts Dermatologist Explains Hibiclens for Hidradenitis Suppurativa
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5. MY Treatment Journey w/ Hidradenitis Suppurativa & Folliculitis | Aisha Richards
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