Approaching Sensitive Exams and Diagnostic Delay in Adolescent HS

This episode, "Approaching Sensitive Exams and Diagnostic Delay in Adolescent HS," features the panel examining how to build trust with adolescent patients during sensitive exams.

Continuing with the adolescent case, Dr. Tjahjono explains that treating a teenager means treating the family, since parents can become the strongest allies in care or, if excluded, a barrier to it. He notes that safety data supporting biologics in younger patients has only become robust in the last several years, giving him more confidence to discuss hope and disease control with families than was possible before. The goal, he says, is halting progression before any irreversible anatomic damage occurs.

The panel turns to the practical challenge of examining sensitive areas in patients who are often deeply uncomfortable with their bodies. Dr. Cices describes offering patients a choice about whether a parent stays in the room, asking permission before any exam, and noting that some patients leave underwear on even when only genital involvement is present, a signal of how hesitant they can be. Cynthia Trickett recalls a patient undergoing gender transition who declined any exam for three visits before eventually agreeing, illustrating that patience itself builds the therapeutic relationship and, over time, treatment adherence. Encouraging patients to fully undress matters clinically too, since disease can exist in areas patients forget to mention or have never noticed.

Asked what drives diagnostic delay, Cynthia Trickett points to shame on the patient side, where embarrassment keeps people silent until they reach crisis, and a parallel delay on the provider side, where urgent care and emergency clinicians often treat and discharge without recognizing HS. Dr. Payette adds a case of his own: a 13-year-old with a single axillary abscess who returned three months later with another, a pattern he says is often enough, on its own, to justify an early diagnosis and intervention.

Up next, in "Starting Biologic Therapy for HS in Adolescent Patients," the panel discusses when and how they introduce biologic therapy to adolescent patients and their families.