Ultimate Guide to Diagnosing Hidradenitis Suppurativa: Symptoms and Lookalikes Explained

Diagnosing hidradenitis suppurativa (HS) involves a thorough examination of the painful, boil-like bumps that develop beneath the skin, especially in areas where skin rubs together.

HS is a persistent skin disorder characterized by painful nodules and abscesses forming under the skin, typically in sweat gland-rich regions. Although some skin conditions may resemble HS, distinct features help healthcare providers identify it accurately.

A dermatologist usually performs the diagnosis by assessing the location, appearance, and nature of the skin lesions.

If any lesions are discharging fluid, a swab may be taken to test for infections, though this is not essential for confirming HS.

Continue reading to understand the diagnostic process for HS and learn when medical advice is necessary.

How is Hidradenitis Suppurativa Diagnosed?

Doctors begin by reviewing your medical history and asking detailed questions about the location and frequency of your skin breakouts. The typical distribution of lesions is a key indicator of HS.

Physical examination focuses on identifying specific characteristics that distinguish HS from common boils, acne, or other similar conditions.

Key signs include:

• Deep, tender nodules beneath the skin
• Blackhead-like spots clustered together
• Large, painful abscesses
• Scarring from previous flare-ups

Doctors also look for recurring patterns and typical lesion placements. While fluid samples may be collected to rule out infection, no laboratory test currently confirms HS definitively.

Which Specialist Should You Consult?

If you suspect you have hidradenitis suppurativa, it is important to see a dermatologist. These skin specialists are trained to diagnose and manage conditions affecting skin, hair, and nails, and can differentiate HS from other similar skin issues.

Conditions That Mimic Hidradenitis Suppurativa

Several skin disorders share symptoms with HS, including:

Skin Infections

Early HS lesions may look like infections with swollen, tender bumps or pus-filled abscesses. Unlike bacterial infections, HS results from an immune system reaction triggered by blocked hair follicles filled with keratin and sweat.

Acne

Both acne and HS start with blocked hair follicles caused by oil, dead skin cells, and bacteria. However, HS affects areas rich in sweat glands and often forms interconnected tunnels under the skin called sinus tracts, which acne does not.

Ingrown Hairs

Ingrown hairs occur when hair curls back into the skin causing inflammation and bumps, especially common in curly hair around the beard and neck. Unlike HS, ingrown hairs pierce the skin from outside causing localized inflammation.

Folliculitis

This is inflammation of hair follicles often caused by irritation, friction, or shaving. Folliculitis bumps can resemble HS but are generally smaller and tend to resolve on their own once triggers are removed.

When Should You See a Doctor?

Early diagnosis and treatment of HS are crucial to prevent scarring and mobility limitations. Consult a healthcare professional if your breakouts are:

• Painful
• Infected (signs include pus, swelling, or spreading discoloration)
• Blistering
• Spreading rapidly

A primary care physician can refer you to a dermatologist for specialized care.

Frequently Asked Questions

Can Blood Tests Detect Hidradenitis Suppurativa?

No blood test currently exists to diagnose HS. Diagnosis is primarily clinical, though swabbing lesions may help detect secondary infections.

What Are Common Treatments for Hidradenitis Suppurativa?

Treatment plans are personalized and may include:

• Gentle skincare routines with benzoyl peroxide washes and mild antiperspirants
• Oral or topical anti-inflammatory and hormonal medications
• Injectable therapies such as biologics or corticosteroids
• Procedures to drain abscesses or remove sinus tracts
• Wound care for slow-healing sores
• Laser hair removal
• Support for associated mental health concerns like anxiety or depression

Summary

Hidradenitis suppurativa is a chronic, painful skin condition marked by boil-like bumps in areas with sweat glands and skin friction. Diagnosis relies on clinical evaluation by a dermatologist familiar with its unique features. Effective management includes a combination of skincare, medications, and sometimes surgical intervention to improve quality of life.

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