Key Distinguishing Features of HS

This episode, titled ‘Key Distinguishing Features of HS,’ features expert dermatologists discussing the key clinical findings and diagnostic strategies that help clinicians confidently identify HS, even when presentations are atypical or active lesions are absent. Dr. Resnik outlines the classic diagnostic hallmark of recurrent abscesses arising in the same location across two or more body areas, but also draws attention to a papulonodular variant characterized by small and large bumps that do not coalesce into the typical HS plaques. He emphasizes the importance of looking for bridging comedones, atrophic scarring, and hyperpigmentation as subtle but telling signs, and stresses that a thorough patient history is essential since social media is increasingly prompting patients to self-identify and seek care even when no active lesions are present at the time of their visit.

Dr. Resnik also encourages clinicians to think beyond classic anatomical sites and consider the broader acne tetrad, which includes dissecting cellulitis of the scalp, acne conglobata, pilonidal cysts or sinuses, and HS itself, as collectively these findings can help build a definitive diagnosis. Dr. Hsiao reinforces the value of the full skin examination, noting that HS lesions frequently appear in less typical locations such as the posterior neck, postauricular region, and back. She stresses that recurrence history, which only the patient can provide, is a core diagnostic criterion and that believing the patient is paramount, as dismissing someone due to a lack of active lesions on a given day can erode trust and drive patients away from care entirely.

Dr. Hsiao also addresses the diagnostic challenge of differentiating deep tunnels in the gluteal or groin area from cutaneous Crohn's disease, noting that pelvic MRI with contrast can help distinguish between the two, as Crohn's-related tunnels tend to run deeper and may involve the anal sphincter, whereas HS tunnels are more characteristically dermal. She highlights the clinical relevance of this distinction given that some treatments are better suited for HS than for inflammatory bowel disease.

In the next episode, ‘The Dermatologist's Role in Early HS Recognition and Long-Term Patient Outcomes,’ panelists will continue their discussion on HS and highlight why dermatologists are uniquely positioned to lead the care of HS patients, while making a compelling case for early intervention to prevent irreversible tissue damage and improve long-term outcomes.