How Do Doctors Diagnose Hidradenitis Suppurativa (HS)?

Hidradenitis suppurativa (HS) is a chronic skin condition that involves the formation of painful, inflamed nodules under the skin. HS is caused by inflammation in the hair follicles, which become blocked. This creates painful, tender knots under the skin that sometimes drain from the surface of the skin.

For best treatment outcomes, early diagnosis is key, according to Erum Ilyas, MD, Dermatologist at Montgomery Dermatology in Pennsylvania. 

An early diagnosis reduces the risk of severe HS symptoms like scarring, open wounds, and infections, she says.

How is HS diagnosed?

HS is usually diagnosed by a dermatologist, a doctor who specializes in treatment of the skin. However, your primary care provider may play a role in recognizing those symptoms and referring you to a specialist.

The doctor will look for three main criteria to diagnose HS. The nodules should be:

• Deep and painful

• Located on the folds of the skin

• Recurring (repeating)

The dermatologist may not need to take biopsies of the skin in order to diagnose HS. “We want to primarily look at those folds of skin to see if there’s any evidence of any of those nodules,” Ilyas explains. 

How do doctors rule out other skin conditions?

The dermatologist may do additional tests or exams to rule out a different skin condition, including a Staph infection. Staph infections can also cause painful bumps on the skin. However, they may appear different in how deep and inflamed they are, as well as the location and distribution. 

 “There are so many other conditions that are often misdiagnosed for HS that it’s really important to make sure that you get the diagnosis right,” Ilyas says.

As far as treatment for HS, it will depend on your symptoms and how your disease has progressed.  “A lot of times, we’ll focus on getting that inflammatory response under control,”  Ilyas explains.