Hidradenitis suppurativa (HS) can be challenging to diagnose. HS is frequently misdiagnosed as a more common skin condition such as acne, boils, cysts, or folliculitis (inflamed hair follicles). As a result, people with HS experience an average delay in diagnosis of seven years.
Hidradenitis suppurativa is diagnosed by a physical exam and medical and family history. In some cases, a doctor may order tests to help determine the cause of skin symptoms. HS is often diagnosed by a dermatologist. A primary care physician can also examine your skin or refer you to a specialist.
Your doctor is evaluating three primary factors when diagnosing HS:
There is no lab test to diagnose HS. However, your doctor can test fluid from ruptured lesions for bacterial culture, perform a skin biopsy, or order imaging to rule out other possible conditions.
Your doctor will take a thorough history, asking about symptoms over time and family medical history. A clear picture may emerge from the medical history that will help assess risk factors that strengthen the suspicion of HS or rule out other conditions.
Your doctor may ask about the following criteria:
Learn more about risk factors for hidradenitis suppurativa.
Your doctor will conduct a thorough exam of your skin symptoms to determine if they are consistent with hidradenitis suppurativa. The doctor may be confident in an HS diagnosis or consider more testing to rule out other conditions.
Other skin conditions can produce symptoms like those of hidradenitis suppurativa. The process of ruling out other conditions with similar signs and symptoms is referred to as differential diagnosis. Conditions that can mimic symptoms of HS include:
Your doctor may be able to rule out many of these conditions quickly based on your medical and family history or other tests, such as a bacterial culture. Many people with HS can appear to have boils, but do not actually have an infection. Ruling out other possible causes of skin lesions can help confirm an HS diagnosis. If you are diagnosed with HS, your doctor may assess the severity of your condition and assign it a stage.
There is currently no cure for HS, but treatments can manage symptoms, improve the course of the disease, and sometimes produce long periods of remission. Treatment options include oral and topical medications and surgical procedures. Lifestyle changes, such as weight loss and smoking cessation, can also help reduce symptoms. For some women, HS symptoms greatly diminish after menopause. Early diagnosis and treatment can address symptoms before HS progresses and becomes more severe.