Topic 7: A Practical Assessment Sequence

Step 1: Count active inflammatory lesions. Document inflammatory nodules, abscesses, draining tunnels, and anatomic regions. Calculate IHS4 when practical.

Step 2: Look for structural damage. Examine and palpate for nondraining and draining tunnels, scarring, fibrosis, tissue distortion, and restricted movement.

Step 3: Ask about disease between visits. Determine flare frequency, typical lesion number, duration, intermittent drainage, new areas, and whether today is typical.

Step 4: Assess patient burden. Ask about pain, drainage, odor, sleep, mobility, work or school, exercise, relationships, and emotional wellbeing.

Step 5: Review treatment response. Document prior treatments, duration, adherence, response, adverse effects, and reasons for discontinuation.

Step 6: Integrate the findings. Ask how active the inflammation is, how much structural damage has occurred, and how much HS is affecting the patient’s life.