Hadar Lev-Tov, MD, MAS 

Panelists discuss how societal factors like embarrassment and limited health care access contribute to diagnostic delays of 6 to 7 years despite HS being clinically straightforward to identify and describe the profound impact on patients’ lives beyond sterile quality of life measures, including loss of relationships, careers, and life milestones.

Diagnostic Challenges in HS and Impact on Patient Quality of Life

Despite hidradenitis suppurativa (HS) being relatively straightforward to diagnose clinically, patients typically experience a delay of 6 to 7 years before receiving an accurate diagnosis. This delay persists due to multiple societal barriers rather than diagnostic complexity, including patient embarrassment about discussing symptoms in sensitive body areas, lack of awareness about the condition, limited access to dermatology specialists, and fragmented health care delivery. Many patients initially receive treatment for infectious abscesses without recognition of the underlying chronic inflammatory condition, leading to cycles of temporary improvement followed by recurrence.

The disease profoundly affects patients’ quality of life in ways that extend far beyond clinical measures, fundamentally disrupting their ability to pursue education, maintain employment, form intimate relationships, and plan families. Patients live with constant concerns about pain, drainage, odor, and the need for extensive bandaging, which can prevent them from participating in normal social activities and physical contact with loved ones. The psychological burden includes significant stigmatization and mental health challenges, with the disease often striking during critical life stages when individuals are establishing careers and relationships.

 represents an inadequate term for describing the devastating impact of HS, which truly represents a loss of life in terms of missed opportunities and experiences. The disease affects patients during their most productive years, preventing them from achieving personal and professional goals that contribute to a fulfilling life span. This recognition of the profound human cost of HS underscores the importance of early diagnosis and aggressive treatment to restore patients’ ability to participate fully in work, relationships, and family life.

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Panelists discuss how HS develops from a combination of genetic predisposition and environmental exposures, leading to immune-based inflammation in skin folds, and explain clinical diagnosis methods, including Hurley staging and assessment of inflammatory lesions.

HS Pathophysiology, Diagnosis, and Classification

Hidradenitis suppurativa (HS) develops through a combination of genetic predisposition and environmental exposures, affecting approximately one-third of patients who have a family history of the condition. The disease involves multiple factors, including immune system dysfunction, metabolic influences, mechanical forces in body folds, and altered wound healing responses. Environmental triggers such as dietary factors, viral exposures, and other pollutants can activate the disease process in genetically susceptible individuals, often beginning during adolescence, when hormonal changes occur.

Diagnosis of HS relies primarily on clinical assessment, with practitioners identifying characteristic recurrent lesions in typical locations including the armpits, groin, under the breasts, and buttocks. The examination focuses on identifying inflammatory nodules, abscesses, and draining tunnels, along with signs like comedones, scarring, and discoloration in affected areas. While Hurley staging remains the standard classification system used in clinical trials to determine disease severity, clinicians also utilize outcome measures based on counting specific lesion types to assess treatment response.

Severity assessment extends beyond physical examination to include the substantial impact on patients’ daily functioning, including pain, drainage, odor, and mental health effects. Practitioners evaluate both the extent of tissue destruction and the disease’s effect on quality of life, recognizing that patients with limited physical disease may experience profound social and emotional consequences. This comprehensive approach considers the number of affected body regions, presence of new lesions in different locations, and the overall burden on the patient’s well-being when developing individualized treatment plans.

Hadar Lev-Tov, MD, MAS

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