Topic 3: Ask About Symptoms the Examination Cannot Measure
Pain is often the most disruptive HS symptom, but the experience is multidimensional. Patients may describe pressure, throbbing, burning, stinging, tenderness, or sudden pain when a lesion opens. Pain may occur during flares, persist between flares, or be worsened by movement and friction.2
Ask about both current symptoms and the worst or typical flare:
| Domain | Suggested question | What the answer may reveal |
| Pain | What is the pain today, and how severe is it during your worst flare? | Peak burden, movement limitation, sleep effects, and need for symptom management |
| Drainage | How often do lesions drain, and how many dressings or clothing changes do you need? | Frequency, unpredictability, wound-care needs, and hidden disease activity |
| Odor | Do drainage or odor affect where you go or how comfortable you feel around others? | Social avoidance, embarrassment, and practical management needs |
| Pruritus | Do affected areas itch, and does itching interfere with sleep? | A symptom that may be missed when questioning focuses only on pain |
| Fatigue | Do HS symptoms or disrupted sleep leave you fatigued during the day? | Cumulative effect on concentration, work, school, and activity |
The 2025 Hidradenitis Suppurativa Symptom and Impact Diary was developed for clinical trials, but its content reinforces clinically important domains: pain, itching, drainage, odor, fatigue, movement, sleep, social interaction, emotions, and work.3