Topic 2: Adolescent HS May Begin Subtly
Pediatric HS can present with deep inflammatory nodules and abscesses, but early findings may also include comedones, papules, pustules, or an apparently isolated cyst. Recurrence, characteristic distribution, pain, drainage, and residual scarring help distinguish HS from a one-time lesion.3
In an international multicenter study of 481 pediatric patients, diagnostic delay was common and many patients already had scarring at the time of diagnosis. The study reinforces the need to ask what occurred before the current visit rather than waiting for a dramatic examination.4
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Subtle residual change may preserve evidence of earlier flares even when no acutely inflamed nodule is present.
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A deep, painful lesion in a typical location should prompt questions about prior episodes and other intertriginous sites.
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Tunnels and characteristic scars support chronic disease, but clinicians should aim to recognize HS before these changes develop.
