What are the key clinical features to consider when diagnosing hidradenitis suppurativa in a primary care setting?

Key clinical features for diagnosing hidradenitis suppurativa (HS) in primary care include:

• Typical lesion types: recurrent, painful, deep-seated nodules, abscesses, and draining sinus tracts or tunnels in characteristic locations such as the axillae, groin, perineum, and inframammary areas.
• Chronicity and recurrence: lesions tend to be chronic and recurrent over months to years, often with scarring and fibrosis developing over time.
• Distribution: lesions are typically bilateral and symmetrical, affecting apocrine gland–bearing areas.
• Associated symptoms: pain, tenderness, malodorous discharge from sinus tracts, and sometimes systemic symptoms like low-grade fever during flares.
• Onset and progression: usually begins after puberty and may worsen over time without treatment.
• Exclusion of other diagnoses: differentiation from boils, carbuncles, pilonidal disease, and acne vulgaris is important, considering lesion morphology and distribution.

Recognising these features in primary care is critical for early diagnosis and referral, as HS is often underdiagnosed or misdiagnosed. Early identification allows for timely management to reduce progression and complications Garg et al. 2023Scuderi et al. 2017 NICE CKS.