HS Case Study: Closing Diagnostic Gaps in Adult Women

"HS Case Study: Closing Diagnostic Gaps in Adult Women" takes up the panel's second case: a 30-year-old woman whose disease has gone unrecognized for years.

The panel's second case is a 30-year-old woman presenting after an urgent care visit for a painful axillary abscess requiring incision and drainage. She reports a five-year history of recurrent nodules, abscesses, and draining lesions in the axilla and groin, long attributed to ingrown hairs and managed only by her primary care physician. Exam findings, including a limited tunnel without extensive interconnection, again place her at Hurley Stage 2. She describes avoiding intimate relationships out of fear over drainage and odor, appears visibly anxious during the exam, and makes self-deprecating comments about hygiene. Her history includes obesity, generalized anxiety disorder, a decade of smoking, and an uncertain family history of HS in her mother, along with multiple prior antibiotic courses, isotretinoin, and repeated incision and drainage.

Dr. Cices calls this pattern distressingly common: patients cycling through primary care with quick fixes that never address the underlying inflammation, developing new lesions and scarring while the root disease goes unnamed. She describes active outreach to emergency departments, gynecology practices, and family medicine to build referral pathways, noting that a simple rule, two boils within a year warrants a dermatology referral, could capture many missed patients earlier.

Asked how to build trust with a patient carrying this much shame, panelists describe opening with gratitude that she came in, then explicitly stating that HS is an immune condition and not her fault. They routinely dispel myths that patients bring in, including fears that HS is sexually transmitted, contagious, or caused by poor hygiene, reframing recommended antimicrobial washes as reducing inflammatory burden rather than correcting uncleanliness.

In "When to Escalate HS Treatment Before Disease Turns Severe," the panel debates when lifestyle counseling belongs in a visit, and when this patient's disease actually qualifies as severe.