The transition from hearing about a tragedy to witnessing it firsthand is deeply jarring. When the friends arrive to comfort the suffering man, the reality of his situation hits them with a shocking visual impact that far exceeds the terrible news they had received. Because seeing the devastation is so much harder than merely hearing about it, their immediate reaction is intense and overwhelming [אלשיך].
As they approach from a distance, they are instantly confronted by his ruined surroundings [ביאור שטיינזלץ]. Looking at their friend, they are entirely unable to recognize him. The primary approach among commentators is that they do not mistake him for a stranger; they know perfectly well who he is, which is why they immediately break down in tears. Rather, they simply cannot recognize his original features [תקות אנוש]. His face and appearance have been completely altered by the sheer volume of his pain, troubles, and suffering [רש״י, מצודת דוד].
His physical condition has deteriorated so severely that his body is unrecognizable, altered by harsh illness, extreme weight loss, and a deep sadness that has ruined his appearance [תקות אנוש]. He is in such agony from his boils that he might even be standing naked or half-naked just to bear the physical pain [ביאור שטיינזלץ].
Confronted with this horrific sight, the friends adopt the severe mourning customs of the time, typically reserved for those grieving the death of children or close relatives [תקות אנוש]. They express their profound grief by crying out loud, weeping, and tearing their garments [ביאור שטיינזלץ]. This display of sorrow reaches its peak when they gather dust and throw it high into the air, far above their heads, letting it fall back down upon them. Throwing dust skyward was a traditional expression of deep mourning and anguish during that era [רש״י, מצודת דוד].