Improving Early Identification and Escalation of HS

"Improving Early Identification and Escalation of HS" closes the series with the panel's advice for colleagues managing HS.

Asked what single change would most improve identification and escalation of uncontrolled HS, Dr. Bush urges clinicians not to be apprehensive about treating the disease or using its medications, framing willingness to engage as the real fix. Reflecting on both patient cases, she imagines how differently their lives would have unfolded had today's options existed four or eight years earlier. She advises developing a personal rhythm for HS visits rather than trying to address everything in one appointment, and knowing the available medications well enough to discuss them with confidence, which she believes reduces apprehension for both provider and patient. Chao offers a two-part answer. For identification, he watches for boils anywhere on the body, the follicular tetrad of pilonidal cysts, scalp cysts, dissecting cellulitis, and severe truncal acne, and even a single inflammatory nodule in the axilla or groin, treating any of these as a reason to monitor closely and ask patients directly about symptoms in sensitive areas. For escalation, he favors a gradual approach: starting with an antibiotic and a topical, asking patients to research the condition and treatment options at home, and building toward a biologic conversation over subsequent visits rather than raising it immediately at diagnosis. Dr. Bush adds that she watches for HS during routine skin checks, sometimes finding it in patients who have had symptoms for decades without a diagnosis, and looks specifically for double comedones and nodular abscesses, asking whether patients have sought urgent care before. She keeps her door open for quick follow-up so patients get diagnosed and treated rather than cycling repeatedly through urgent care visits. Chao closes by thanking Dr. Bush and the audience, encouraging viewers to apply the strategies discussed in their own practices going forward.

Thank you for watching this Dermatology Times Case-Based Peer Perspectives series on hidradenitis suppurativa. Please subscribe to our eNewsletter for information on upcoming video series.