Hidradenitis Suppurativa (HS) – The Path to Diagnosis

Posted on August 19, 2019

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).1 As a result, people with HS experience an average delay in diagnosis of seven years.2

How is hidradenitis suppurativa diagnosed?
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.3 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:4

  1. Recurring skin lesions consistent with HS
  2. Family history of HS
  3. Ruling out other possible conditions


Tests and what they show
There is no lab test to diagnose HS. However, your doctor can test fluid from ruptured lesions, perform a skin biopsy, or order imaging to rule out other possible conditions.3,5

Medical history
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 them assess risk factors that strengthen the suspicion of HS or rule out other conditions.

Your doctor may ask about the following criteria:

  • Frequency of lesions – Recurring lesions (at least two in six months) support an HS diagnosis.4
  • A relative with HS – Approximately one-third of people with HS have a blood relative with the condition.6
  • Acne – There is some evidence that HS may be more common in people with acne.
  • Polycystic ovary syndrome (PCOS) – There is some evidence that HS may be more common in people with PCOS.7
  • Obesity – Being overweight does not cause HS, but it may increase the risk of developing HS and worsen the severity of HS symptoms.7
  • Smoking – Tobacco use may increase the chances of developing HS and aggravate symptoms.7

Learn more about risk factors for hidradenitis suppurativa.

Physical exam
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.3

Ruling 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:1

  • Acne
  • Boils
  • Cysts
  • Folliculitis (inflamed hair follicles)

Your doctor may be able to rule out many of these conditions quickly based on your medical and family history or other tests. 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.

What is the prognosis for hidradenitis suppurativa?
There is no cure for HS, but treatments can manage symptoms, improve the course of the disease, and sometimes produce long periods of remission. In some cases, HS symptoms greatly diminish after menopause. Treatment options include oral and topical medications and surgical procedures. Home remedies and lifestyle changes can also help reduce symptoms.8,9 Early diagnosis and treatment can address symptoms before HS progresses and becomes more severe.2

Resources

External Resources


Internal Resources


References

  1. Hidradenitis suppurativa. (n.d.). Retrieved June 26, 2019, from https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa
  2. Armstrong, W. (2017, November 28). The Largest-Ever Epidemiological Study Brings Hidradenitis Suppurativa Into Sharp Focus. Retrieved July 26, 2019, from https://www.medpagetoday.com/resource-centers/advances-in-dermatology/largest-ever-epidemiological-study-brings-hidradenitis-suppurativa-into-sharp-focus/1641
  3. Hidradenitis suppurativa: Diagnosis & treatment. (2019, May 16). Retrieved June 26, 2019, from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/diagnosis-treatment/drc-20352311
  4. Zouboulis, C., Desai, N., Emtestam, L., Hunger, R., Ioannides, D., Juhász, I., … Jemec, G. (2015). European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. Journal of the European Academy of Dermatology and Venereology,29(4), 619-644. Doi:10.1111/jdv.12966
  5. Rothstein, B., Scheinfeld, N., MD, Huang, W. W., MD, MPH, & Feldman, S. R., MD, PhD. (n.d.). What Are the Diagnostic Criteria for HS? Retrieved July 2, 2019, from https://www.consultant360.com/exclusives/etiology-and-diagnosis-hidradenitis-suppurativa
  6. Hidradenitis suppurativa. (n.d.). Retrieved June 26, 2019, from https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa#causes
  7. Harding, M. (2016, December 2). Hidradenitis Suppurativa: HS: Causes, Tests & Treatment. Retrieved July 26, 2019, from https://patient.info/skin-conditions/hidradenitis-suppurativa-leaflet
  8. Hidradenitis Suppurativa Management and Treatment. (2018, February 23). Retrieved June 26, 2019, from https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa/management-and-treatment
  9. Hidradenitis suppurativa: Symptoms & causes. (2019, May 16). Retrieved June 26, 2019, from https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/symptoms-causes/syc-20352306
myHSteam My hidradenitis suppurativa Team

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