diagnosing hs diagnosing hs


Patient portrayal

An early
diagnosis of HS
can help mitigate
disease burdens1

Hidradenitis suppurativa (HS) can be challenging to diagnose as the
clinical characteristics may be difficult to identify or mistaken for other
conditions. But the consequences of a delayed HS diagnosis can be
damaging and may even be permanent. Recognizing the characteristic
lesions of HS and how they present across different skin tones can help
get patients the care they need to help inhibit further disease

Ask your patients Have you had
of boils
during the
last 6 months, and if
where and how

If yes, it
could be HS
Up to ~90% sensitivity in

There are 3 essential diagnostic criteria that can
help distinguish HS from other skin conditions6


One or more painful, inflammatory,
deep-seated nodules, abscesses, or


Lesions are most common on flexural sites,
like the axillae, inframammary, groin, perineal
and perianal regions. They are less common
on ears, face, scalp, back, chest, or legs.3,6


Recurrence at least twice within 6
months and/or persistence of at
least 3 months2,7

Commonly Involved Areas

Commonly Involved Areas3,6

  • Inframammary region

    Inframammary region

  • Inframammary region


  • Inframammary region


  • Inframammary region

    Buttocks and perianal

  • Inframammary region

    Perineal region

Less common Areas2 Around the ears, back, face, scalp, chest, and legs

Know HS when you see it

Early HS lesions may resemble other dermatological conditions. Knowing the common presentations, common differential diagnoses, and
stage of disease can help you identify HS more quickly and make referrals to HS-treating dermatology providers sooner.2

  • Image of hidradenitis suppurativa abscesses lesions

    Image of abscess of HS patient provided by
    Dermatology Online Journal, copyright Noah Scheinfeld,

  • Image of hidradenitis suppurativa nodules lesions

    Image of nodule of HS patient provided by DermNet.

  • Image of hidradenitis suppurativa follicular papule/pustule lesions
    Follicular papule/pustule

    Image of follicular papules/pustules of HS patient
    provided by Dermatology Online Journal, copyright Noah
    Scheinfeld, MD.

  • Tunnel

    Image of sinus tract/fistula of HS patient provided by
    Experimental Dermatology.

  • Scar/cord

    Image of cord/scar of HS patient provided by
    Dermatology Online Journal, copyright Noah Scheinfeld,

  • Comedone

    Image of comedones of HS patient provided by
    American Family Physician.

  • Image of folliculitis

    Image provided by International Journal of Dermatology.

  • Image of carbuncle

    Image provided by Science Source.

  • Image of cutaneous Crohn's disease
    Cutaneous Crohn's disease

    Image provided by British Medical Journal.

  • Tunnel
    Acne vulgaris

    Image provided by Journal of Clinical and Aesthetic Dermatology.

  • Scar/cord
    Intergluteal pilonidal cysts

    Image provided by Science Source.

  • Comedone
    Pyogenic granuloma

    Image of granuloma provided by iStock.

  • Image showing mild HS referred as Hurley Stage 1

    Image of inframammary fold of HS patient provided by Dr Ali Moiin.

    Sometimes described as Hurley Stage 1.
    Typically presents as 1 or more nodules
    with no to minimal scarring or tunnel

  • Image showing moderate HS referred as Hurley Stage 2

    Image of axilla of HS patient provided by Science Source.

    Sometimes described as Hurley Stage 2.
    Typically presents as multiple nodules along
    with limited tunneling and/or scarring.

  • Image showing severe HS referred as Hurley Stage 3

    Image of axilla of HS patient provided by Science Source.

    Sometimes described as Hurley Stage 3.
    Typically presents as multiple or
    extensive interconnected tunnels, nodules,
    and scarring.

HS can appear differently depending on skin tone19

Hidradenitis suppurativa disproportionally affects patients of color and is associated with increased disease severity. Knowing the clinical
presentations of HS on darker skin tones may help you accurately identify HS.4,19

Presentations of HS unique to patients of color

Subtle erythema on HS patient

Subtle erythema20

Image of axilla of HS patient provided by Science Source.

Violaceous, dark brown, and gray lesions on HS patient

Violaceous, dark brown, and gray lesions20

Image of groin of HS patient provided by Dr Ali Moiin.

Post-inflammatory dyspigmentation on HS patient

Post-inflammatory hyperpigmentation1,21

Image of axilla of HS patient provided by Science Source.

Keloids on patient


Image of chest provided by Science Source.

Hear from your peers about identifying and diagnosing HS



The healthcare providers featured in these videos were compensated for their time. These videos represent their opinions and do not represent the opinions of Novartis.

women are 3x more likely than man

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References: 1. Sabat R et al. Nat Rev Dis Primers. 2020;6(1):18. 2. Saunte DML et al. JAMA. 2017;318(20):2019-2032. 3. Kimball AB et al, eds. Hidradenitis Suppurativa: A Disease Primer. Adis; 2017. 4. Kilgour JM et al. JAAD Int. 2021;3:42-52. 5. Vinding GR et al. Br J Dermatol. 2014;170(4):884-889. 6. Revuz J. J Eur Acad Dermatol Venereol. 2009;23(9):985-998. 7. Zouboulis CC et al. Exp Dermatol. 2021;30(suppl 1):27-30. 8. Fitzpatrick TB. Arch Dermatol. 1988;124(6):869-871. 9. Scheinfeld N. Dermatol Online J. 2014;20(4):22373. 10. Daxhelet M et al. Dermatology. 2020;236(5):431-438. 11. Martorell A et al. Dermatol Surg. 2019;45(1):1237-1244. 12. Frew J et al. JAMA Dermatol. 2021;157(4):449-455. 13. Elkin K et al. Skin Res Technol. 2021;26(1):11-19. 14. Margesson LJ et al. Best Pract Res Clin Obstet Gynaecol. 2014;28(7):1013-1027. 15. Micheletti RG. Semin Cutan Med Surg. 2014;33(suppl 3):S48-S50. 16. Winters RD, Mitchell M. Folliculitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022. PMID: 31613534. 17. Deckers IE et al. Curr Derm Rep. 2014;3(1):54-60. 18. Alikhan A et al. J Am Acad Dermatol. 2019;81(1):76-90. 19. Okeke CAV et al. Dermatology. 2022;238(1):180-184. 20. Heath CR et al. Cutis. 2022;110(3):159-160. 21.Taylor S et al. J Cutan Med Surg. 2009;13(4):183-191. 22. Jfri A et al. JAAD Case Rep. 2019;5(8):675-678.

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