Topic 4: Recurrence May Be the Most Important Clue

A single inflamed nodule or abscess may have several possible causes. Repeated episodes in characteristic areas should increase suspicion for HS.¹

Questions that help establish recurrence include:

• Have you had a similar lump in this location before?
• How often do these lesions return?
• Do they recur in exactly the same place or in multiple skinfolds?
• Do they completely resolve between episodes?
• Have any lesions drained without being opened?
• Have you received antibiotics or undergone drainage for similar lesions?
• Do you have scars from previous episodes?
• Does anyone in your family experience similar recurring lesions?

A commonly used clinical screening threshold is at least 2 episodes within 6 months. This threshold should support, rather than replace, clinical judgment. A longer history of intermittently recurring lesions can also be highly informative.²

Hidden disease

The patient’s skin may appear relatively quiet on the day of the visit. HS fluctuates, and the visible examination may underestimate:

• The number of recent flares
• The extent of pain
• Intermittent drainage
• Disease in areas not examined
• Repeated treatment elsewhere
• The effect on movement, work, school, sleep, exercise, or relationships

Patient-provided photographs can help document prior flares when appropriate and permitted by the clinical setting. A body-site diagram may also help patients identify areas they are uncomfortable discussing initially.