Topic 7: Put the 3 Diagnostic Clues Together
Use a simple recognition framework:
1. Lesions
Are there deep inflammatory nodules, abscesses, comedones, draining openings, tunnels, or characteristic scars?
2. Locations
Do the lesions occur in one or more intertriginous or friction-prone areas?
3. Recurrence
Have similar lesions returned over time, whether in the same site or another characteristic region?
When all 3 elements are present, HS should be strongly considered. The next step is to assess the full extent of disease and its effect on the patient, not simply treat the most visible lesion.1
Atypical presentations
The 3-clue framework describes a typical presentation, but HS does not always follow the classic combination. A patient may have typical HS lesions in less typical locations, such as the waistline, neck, or periauricular skin. Conversely, recurrent folliculitis-like lesions or open comedones may occur in typical HS locations.7
An atypical site or morphology should not automatically exclude HS. Look for recurrence, involvement of other characteristic sites, scarring, paired comedones, draining openings, or other findings that reveal the broader pattern.