Hidradenitis suppurativa diagnosis and management in primary care: not just recurrent boils

BACKGROUND

Hidradenitis suppurativa (HS) is characterised by inflamed skin lesions and scars that occur in apocrine-gland-bearing areas including axillae, inframammary folds, and groin, with a chronic course including flares.¹ It is associated with an average diagnostic delay of 7.2 years and has a Western population prevalence of approximately 1%–2%.^2,3 HS affects young to middle-aged adults and is more common in women. It is 2–3 times more common in people with skin of colour especially those of African American descent.² HS significantly impacts general health and quality of life. A recent cross-sectional survey of GPs found that, while patients were largely managed appropriately, there was suboptimal management of pain, psychosocial aspects, and comorbidity screening.⁴ The current article aims to address this educational need.

WHY IS THE DIAGNOSIS OF HIDRADENITIS SUPPURATIVA IN PRIMARY CARE SO IMPORTANT?

Historically, HS was poorly recognised and under-researched. Patients are often treated sub-optimally and comorbidities are not managed. Practitioners in primary care can both diagnose and treat early disease. They can address comorbidities, support lifestyle changes, and offer psychological support.

WHAT ARE THE IMPORTANT ELEMENTS IN THE PATIENT’S HISTORY AND EXAMINATION?

Three main elements need to be considered in a diagnosis of HS:

• skin changes:

  • — deep-seated painful nodules, abscesses, tunnelling, double-ended comedones, tombstone scarring, and rope-like scars may exist (Figure 1);

• locations of lesions:

  • — for example, the axilla, groin, chest, abdominal fold, and perineum; and

• duration:

  • — lesions are chronic with regular relapses, often at previous sites, and at least two lesions in the last 6 months.^{5 …}