How Hidradenitis Suppurativa Is Diagnosed

It's estimated that up to 4% of the population has hidradenitis suppurativa, but many believe it's actually more common and that many cases go either undiagnosed or unreported. Diagnosing hidradentitis suppurativa can be challenging in some cases because symptoms can come and go, and they resemble other skin conditions. The three factors that can be used to diagnose this condition include the type of lesions that develop (nodules, abscesses, and sinus tracts), where these lesions appear (generally in the armpit, groin, buttocks, and gential area), and the chronic recurrence of these lesions.

Self-Checks/At-Home Testing

Make note of where and when you detect lumps or abscesses. Make a symptom diary that you can share with your health care provider. If you have any ongoing conditions, make note of those as well, including flares or trends. You may ask family members if they or other relatives have ever had similar problems with skin conditions.

Embarrassment often keeps people from seeing a doctor until the condition has worsened to a point that it simply cannot be ignored. This embarrassment may come from the unpleasant odor that accompanies the condition, or the fact that they often appear in initmate areas such as the genitals, cleft of the buttocks, or around the anus.

If you have any type of painful lump or abscess, especially if these recur with regularity, it's very important that you see your physician for a diagnosis. Hidradenitis suppurativa is a chronic, progressive disease. This means it will not get better on its own; in fact, it most likely will continue to worsen as time goes on.

Physical Exam and Medical History

In general, your physician will make the diagnosis through a review of your symptoms, medical history, and a physical exam of the affected areas. During your exam, be prepared to answer these questions:

  • When did the symptoms begin (how long have you had the lumps/abscesses?)
  • Do the lumps come and go?
  • How often do you get them (e.g. every month, every six months, etc.)?
  • Do you get lumps anywhere else on your body?

Your doctor will also take a look at other factors, including if anyone in your family has been diagnosed with hidradenitis suppurativa, or if you have a history of conditions that have been associated with hidradenitis suppurativa (like inflammatory bowel disease or metabolic syndrome).

There are three main factors that dermatologists use to positively diagnose hidradenitis suppurative. They are:

  • Types of lesions present: Nodules, abscesses, sinus tracts, scarring, and double-ended pseudocomedones (blackheads with two connecting ends)
  • Location of breakouts: Chiefly armpits, groin, inner thighs, gential area, and buttocks
  • Recurrence: Breakouts keep appearing in the same area over a period of months

Classifying Hidradenitis Suppurativa Severity

The Hurley clinical staging system is used to determine the severity of hidradenitis suppurativa. It's important to gauge how severe your condition is to allow your physician to create an appropriate treatment plan.

The Hurley clinical staging system is as follows:

  • Hurley stage I: Mild; just a small handful of nodules or abscesses, without sinus tracts or scarring.
  • Hurley stage II: Moderate; several nodules and abscesses, with sinus tracts and some scarring, but areas of healthy skin in between.
  • Hurley stage III: Severe; clusters of abscesses across the entire area, with interconnected sinus tracts and obvious scarring.

Remember, though, that your particular case may not fit neatly into one of these categories. The Hurley classification is used as a guide. Also, you may move between these categories as the condition progresses or improves.

Labs and Tests

There are no specific lab tests or biopsies to diagnose hidradenitis suppurativa. Your doctor may, however, also order some labs and tests to help rule out other possible causes of the lesions. These may include:

Again, these tests won't diagnose hidradenitis suppurativa; instead they are used to help rule out other causes and help make a diagnosis by elimination. These are more likely to be done if hidradenitis suppurativa isn't presenting in the typical fashion.

Differential Diagnoses

Hidradenitis suppurativa is often misdiagnosed because it so resembles many other skin conditions.

Hidradenitis Suppurativa Is Often Misdiagnosed

Misdiagnosis of hidradenitis suppurativa is incredibly common. It's believed most people have this condition for an average of 7 to 12 years (depending on the study cited) before it is correctly diagnosed.

If you have been dealing with recurrent abscesses in your armpit area, genital area, buttocks, and have already seen a primary care physician, you may wish to ask for a referral to a dermatologist. Seeing a dermatologist as soon as possible makes it more likely you'll get the correct diagnosis quickly, and be able to move on to effectively treating the condition.

Your doctor will consider these other diagnoses as well as hidradenitis suppurativa:

Abscesses

Abscesses, also called boils, are inflamed, fluid-filled sacs that develop under the surface of the skin. They develop when an infection takes hold under the skin. Most often it's caused by bacteria that enter through a small break in the skin.

Furuncles and Carbuncles

Furuncles are small abscesses that develop in a hair follicle. Carbuncles develop when multiple hair follicles become infected. In other words, carbuncles are multiple furuncles that form together in a group. Furuncles and carbuncles are painful.

Folliculitis

Folliculitis is inflammation of the hair follicles. It can appear anywhere on the body where hair is present. It causes red, acne-like pimples across the skin and resembles early-stage hidradenitis suppurativa.

This is a very common skin problem, and one that is caused by a wide variety of factors—from friction, to shaving, to exposure to an irritant. Folliculitis is common in the genital area, as well as in the beard area for men.

Epidermoid Cysts

Epidermoid cysts are the most common type of skin cyst. Generally, they look like soft, round, raised lump on the skin. If it ruptures, though, it be very painful and may leak fluid.

These types of cysts are very slow-growing. They often develop on the face and neck, but can also appear around the genitals as hidradenitis suppurativa does.

Pilonidal Cyst

Pilonidal cysts are exceedingly painful cysts that develop at the crease of the buttocks. They are more common in men than in women. These cysts are red, swollen, and may rupture and leak. Pilonidal cysts, in the vast majority of cases, need to be surgically removed.

A Word From Verywell

It's important to realize that there is not a need to feel embarrassed or ashamed by the symptoms of hidradenitis suppurativa. Having this condition is not your fault, and your doctor will not judge you for it. Your physician treats conditions such as this every day. The main thing is to get a correct diagnosis so that you can be treated.

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Article Sources

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  2. Lee EY, Alhusayen R, Lansang P, Shear N, Yeung J. What is hidradenitis suppurativa? Can Fam Physician. 2017 Feb;63(2):114-120.