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Herpes vs Pimple: how to tell the difference
Written and reviewed by Slava Fuzayloff | Published on June 1, 2024
When we (doctors) try to differentiate between two medical conditions, we compare two parts of those diseases: history and the visual exam. What does each part mean?
1. History is about:
✓ What caused the rash?
✓ How soon did the rash appear after exposure (the rash incubation period)?
✓ How are the rash and other symptoms changing over time?
2. Visual exam is when we:
✓ Look at the rash
✓ Notice the location of the rash
✓ Pay attention to any discharge from the lesion
✓ Skin depth affected by the lesion
In medical practice, 90% of diagnoses are based on a visual exam and 10% on the history of the rash. So, the history of the rash plays a confirmatory role.
This infographic provides a summary of the comparison between genital herpes and folliculitis (also known as pimples)
History
What caused the rash?
Pimple- also known as folliculitis-is caused by irritation of the hair follicles and subsequent infection of them.
If there is a history of shaving or rubbing, pimples are possible.
Unlike a pimple, a herpes lesion [1] Genital Herpes – CDC Detailed Fact Sheet https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm occurs after sexual activity when the skin comes into contact with infected skin(even without a visible herpes sore) and transmission occurs. [4] Folliculitis https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634
How soon did the rash appear?
The incubation period is essential to differentiating herpes [3] Genital herpes: Overview https://www.ncbi.nlm.nih.gov/books/NBK525769/ from pimples [4] Folliculitis https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634 . It is shorter for pimples (folliculitis).
Unlike herpes, which generally takes 2–4 days [3] Genital herpes: Overview https://www.ncbi.nlm.nih.gov/books/NBK525769/ for skin symptoms to appear, pimple symptoms occur in a few hours or, at most, by the next day.
How are symptoms evolving?
What precedes the appearance of a herpes rash and how herpes lesions evolve differentiate herpes from pimples
[3, 4]
Genital herpes: Overview
https://www.ncbi.nlm.nih.gov/books/NBK525769/
Folliculitis
https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634
✓ A herpes rash usually precedes flu-like systemic symptoms, such as fever, chills, fatigue, and “nerve pain.”
On the other hand, pimples do not have a prodrome period—that is, nothing precedes the rash’s appearance.
✓ A herpes rash goes through multiple stages (skin redness, blister, sore, crusted sore).
A pimple, however, appears suddenly and stays in one stage: bumps filled with pus called abscesses.
✓ Herpes skin lesions are always very painful and worsen with irritation.
Pimple bumps are painful only if they’re touched.
✓ Herpes presents with localized groin lymph node enlargement on the side of the rash. Pimples do not present with enlarged lymph nodes unless a huge skin area is involved, which is very severe.
✓ Herpes lesions last 7 to 10 days, whereas a pimple rash usually heals within a few days.
A herpes rash heals without scarring since it affects only a superficial layer of skin. Pimple bumps might cause discoloration or even scarring after they heal.
These pictures show the differences between herpes and pimple sores.
Warning
Contains sensitive content
View Photos
Herpes
Folliculitis
Visual exam
Where on the body do lesions appear?
Herpes lesions mostly appear on the skin bordering the mucosa [2] Genital Herpes Symptoms, Pictures, and Treatment https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes (thinner, moist skin).
Pimples appear around hair follicles. (You may even notice hair coming out of the lesions). They occur in the thicker skin of the thighs, pubic area, and buttocks.
How much skin is affected?
Pimples affect a larger skin area and are usually widespread, affecting both sides of the body (left and right) [5] Folliculitis https://my.clevelandclinic.org/health/diseases/17692-folliculitis
A herpes rash is usually one-sided and affects a minimal skin area—one dermatome.
What do the lesions look like?
Pimple lesions are individual bumps on a red base separated by normal skin.
Herpes lesions are clustered and share a red base.
How are the lesions shaped?
Lesions caused by pimples have an almost perfectly round dome shape and are filled with pus (whiteheads).
Herpes lesions may have different shapes and are filled with clear or yellowish fluid.
How deeply does the rash penetrate the skin?
A herpes rash involves a very superficial area of the skin.
Pimple bumps affect deeper skin areas, as can be felt with a pinch test or seen visually as swelling or thicker skin.
What is discharge from the lesions like?
Herpes has minimal watery discharge for a short time (when a blister turns into a sore).
Pimple lesions have a thicker discharge for a longer time.
Herpes or Folliculitis-learn how to tell the difference. Expert STD doctor (Slava Fuzayloff) explains.
Source
-
Genital Herpes – CDC Detailed Fact Sheet
https://www.cdc.gov/std/herpes/stdfact-herpes-detailed.htm -
Genital Herpes Symptoms, Pictures, and Treatment
https://www.webmd.com/genital-herpes/ss/slideshow-genital-herpes -
Genital herpes: Overview
https://www.ncbi.nlm.nih.gov/books/NBK525769/ -
Folliculitis
https://www.mayoclinic.org/diseases-conditions/folliculitis/symptoms-causes/syc-20361634 -
Folliculitis
https://my.clevelandclinic.org/health/diseases/17692-folliculitis
