HS Case Study: Recognizing Moderate Disease in an Adolescent

In "HS Case Study: Recognizing Moderate Disease in an Adolescent," the panel examines its first case: a 17-year-old with an 18-month history of painful nodules and abscesses.

The panel introduces its first case: a 17-year-old girl with an 18-month history of painful, recurrent nodules and abscesses in the axilla and groin, with flares that seem to worsen around her menstrual cycle. On exam she has inflammatory nodules and abscesses in both axillae, early scarring, and a limited tunnel on the left, placing her at Hurley Stage 2. She has stopped attending gym class, avoided her school prom, and told no one, including friends or teachers, about her condition. Her mother, frustrated that prior providers dismissed the lesions as acne, accompanies her; the patient rates her average pain at six out of ten, rising to nine during flares. Prior treatments, including antiseptic washes, topical and oral antibiotics, and a clindamycin-rifampin combination, brought minimal relief.

Cynthia Trickett says her first question with any HS patient is whether they are biologic-eligible, and this patient clearly is: two affected body areas, Hurley Stage 2 disease, and a significantly impaired quality of life after 18 months make her a textbook case for early, aggressive treatment. Trickett notes how often patients describe feeling dismissed, cycling through providers who repeat the same advice to lose weight or wash more before eventually losing hope. She stresses that establishing trust and empathy is the essential first step, since patients often need to feel heard before they can engage with treatment.

The panel discusses acting as detectives, asking patients when their first lesion appeared, how long flares last, and how heavily the disease weighs on daily life. They observe that simply naming the diagnosis and acknowledging its toll frequently brings patients to tears, a reaction they've all learned to expect and meet with reassurance that missed adolescent milestones, like this patient's prom, still deserve validation and a path forward.

The next episode in this series, "Approaching Sensitive Exams and Diagnostic Delay in Adolescent HS," has Dr. Tjahjono walking through how he approaches sensitive exams and diagnostic delay in teenage patients.