How is Hidradenitis Suppurativa diagnosed?

TL;DR: Hidradenitis suppurativa is diagnosed primarily through a clinical examination by a dermatologist who evaluates the location, appearance, and recurrence of painful skin lesions. There is currently no single blood test or genetic marker to identify the condition, making a thorough physical assessment and medical history review the gold standard for diagnosis.

How is a diagnosis of Hidradenitis Suppurativa reached?

Because there is no definitive laboratory test for hidradenitis suppurativa, the diagnosis is based on clinical presentation. A dermatologist will typically look for three specific criteria: the presence of typical lesions (such as nodules, abscesses, or sinus tracts), a characteristic distribution in areas like the armpits or groin, and a history of recurrence. Many patients experience a long "diagnostic odyssey," often waiting several years to receive an accurate diagnosis, as the condition is frequently misidentified as simple boils or poor hygiene.

What diagnostic tools and examinations are used?

While the diagnosis is clinical, physicians may use specific investigations to rule out other infections or complications. Hidradenitis suppurativa diagnostics may include:

• Clinical Physical Examination: Assessing the Hurley Staging system (Stage I, II, or III) to determine the severity of inflammation and scarring.


• Bacterial Cultures: Swabbing the pus or discharge to rule out secondary bacterial infections like Staph or MRSA.


• Biopsy: Rarely performed unless the physician suspects an alternative diagnosis, such as squamous cell carcinoma or other inflammatory skin disorders.


• Imaging: Ultrasound or MRI may be used in complex cases to map the extent of deep-tissue sinus tracts or tunnels beneath the skin.

What is the differential diagnosis for Hidradenitis Suppurativa?

Hidradenitis suppurativa is frequently confused with other conditions, which contributes to the delay in diagnosis. Doctors must distinguish it from common skin issues, including furunculosis (multiple boils), pilonidal cysts, Crohn’s disease (which can present with similar perianal lesions), and lymphadenitis. Because hidradenitis suppurativa affects the immune and endocrine systems, it is vital to differentiate it from other folliculitis-related disorders to ensure the correct treatment plan—such as biologics or specialized surgical interventions—is initiated.

Why is it important to see a specialist?

We understand that the journey to diagnosis can be exhausting and isolating. With 729 members of the DiseaseMaps community currently navigating life with hidradenitis suppurativa, we know that many patients are told their symptoms are related to weight or hygiene, which is clinically inaccurate. Seeking a board-certified dermatologist who specializes in inflammatory skin conditions is crucial. A specialist will recognize the systemic nature of hidradenitis suppurativa and can prevent the progression toward severe scarring or systemic infections by starting appropriate anti-inflammatory or immunosuppressive therapy early.

Next steps

• Schedule an appointment with a dermatologist who specifically lists hidradenitis suppurativa as an area of clinical interest.


• Keep a detailed "lesion diary" documenting the location, frequency, and duration of your outbreaks to show your physician.


• Join the DiseaseMaps.org community to connect with others who have navigated the diagnostic process and can offer support.


• Ask your provider about the Hurley Staging system to better understand the severity and management options for your specific case.

Medical disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment; always seek the advice of your physician or other qualified health provider with any questions regarding a medical condition.

References

• NIH Genetic and Rare Diseases Information Center (GARD) - Hidradenitis Suppurativa.


• Orphanet: Portal for rare diseases and orphan drugs (ORPHA: 399).


• OMIM (Online Mendelian Inheritance in Man) - Entry #142690.


• American Academy of Dermatology (AAD) Clinical Guidelines for Hidradenitis Suppurativa.