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Hidradenitis Suppurativa (HS) – The Path to Diagnosis

Posted on August 19, 2019
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Alison Channon

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.

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. 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:

  1. Recurring skin lesions consistent with those of HS in location and quality
  2. Family history of HS
  3. Other possible conditions that can be ruled out

Diagnostic Tests and What They Show

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.

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 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.
  • A relative with HS — Up to 40 percent of people with HS have a blood relative with the condition.
  • Acne — There is some evidence that HS may be more common in people with acne, although most people with acne do not develop HS.
  • Polycystic ovary syndrome (PCOS) — Some studies have shown that HS may be more common in people with PCOS.
  • Obesity — Being overweight does not cause HS, but it may increase the risk of developing HS and worsen the severity of HS symptoms.
  • Smoking — Tobacco use may increase the chances of developing HS and aggravate symptoms. Stopping smoking may aid in the treatment of HS.

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.

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:

  • 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, 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.

What Is the Prognosis for Hidradenitis Suppurativa?

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.

Condition Guide

All updates must be accompanied by text or a picture.
Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Alison Channon has nearly a decade of experience writing about chronic health conditions, mental health, and women's health. Learn more about her here.

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