Fast Five Quiz: Hidradenitis Suppurativa Presentation and Diagnosis

William D. James, MD


May 12, 2020

The diagnosis of hidradenitis suppurativa is primarily a clinical one; no pathognomonic test is available, and biopsy is seldom required, particularly when lesions are well developed. Typical lesions, characteristic distribution, and recurrence are the three key elements required for a definitive diagnosis of hidradenitis suppurativa.

Typical lesions, or primary lesions, include the following:

  • Painful and/or tender erythematous papules < 1 cm in diameter

  • Painful and/or tender erythematous nodules > 1 cm in diameter

  • Painful or tender abscesses and inflamed, discharging papules or nodules

  • Dermal contractures and rope-like elevation of the skin

  • Double-ended comedones

Characteristic distribution includes involvement of the axillae,genitofemoral area, perineum, and gluteal area; in women, the inframammary area may also be involved.

As noted, recurrent painful or suppurative lesions more than twice in 6 months is another key component for a definitive diagnosis to be made.

Learn more about the diagnostic criteria for hidradenitis suppurativa.

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