Forum for Nordic Dermato-Venereology Nr1,2019 | Page 25

Dorra Bouazzi, Ditte M. L. Saunte and Gregor B. E. Jemec – Subtle Clues in Hidradenitis Suppurativa Diagnosis
the clinician to strengthen the suspicion of HS: (i) morpholog-
ical manifestations (i.e. tombstone comedones and scars close
to the lesion); (ii) chronicity (or recurrence) of the eruptions
(nodules, abscess or tunnels); (iii) multiple eruptions in the
intertriginous skin areas (groin, axilla, buttocks, mamma, etc.);
and (iv) family history of HS.
C onclusion
Occasionally the diagnosis of HS is not obvious, but relies on
more subtle clues, as presented in the clinical cases described
here. It is important that clinicians develop the skill to differ-
entiate between HS and infectious abscesses, and thereby avoid
Fig. 3. Case 2: Deep-red nodule (green arrow) with nearly placed scars
(red arrows) in the groin.
Examination revealed a red inflamed nodule, together with
another important clinical sign of HS, namely scars. Scars
close to the lesion illustrate that the patient has had previous
similar eruptions. Since HS is a chronic disease, scars are an
important clue when diagnosing HS.
D iscussion
It is sometimes difficult to differentiate between HS nodules/
abscess and bacterial abscesses. The following clues may help
Forum for Nord Derm Ven 2019, Vol. 24, No. 1
HS patients having to undergo unnecessary procedures, which
may be both physically difficult and emotionally exhausting.
R eferences
1. Zouboulis CC, Del Marmol V, Mrowietz U, Prens EP, Tzellos T, Jemec
GB. Hidradenitis suppurativa/acne inversa: criteria for diagnosis,
severity assessment, classification and disease evaluation. Derma-
tology 2015; 231: 184–190.
2. Scheinfeld N. An atlas of the morphological manifestations of
hidradenitis suppurativa. Dermatol Online J 2014; 20: 22373.
3. Ritz JP, Runkel N, Haier J, Buhr HJ. Extent of surgery and recur-
rence rate of hidradenitis suppurativa. Int J Colorectal Dis 1998;
13: 164–168.
C ase R eport
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