Topic 2: Reconstruct the Disease Course

A useful HS history is chronological. Begin with onset, then identify the pattern of recurrence, the number and duration of flares, whether the disease ever fully clears, and whether new regions or structural findings have appeared.

Questions that establish activity over time

• When did the first lesion occur, and when did the current pattern begin?
• How often do flares occur, and how long do they usually last?
• Are there symptom-free periods, or is at least one area almost always active?
• Which locations have ever been involved, even if they are clear today?
• Do lesions recur in the same places?
• How many lesions are typical during a flare?
• Have you noticed new openings, persistent drainage, thickened scars, or areas that feel connected beneath the skin?
• Is today typical, better, or worse than usual?

Avoid requiring perfect recall. Patients may not know exact lesion counts or dates. Approximate frequency, typical duration, affected regions, and the difference between best and worst days are often more clinically useful than false precision.