Topic 6: Assess Context Without Assigning Blame
Pediatric HS is associated with conditions including obesity, acne, metabolic disease, polycystic ovary syndrome, inflammatory bowel disease, Down syndrome, and mental-health concerns. Assessment should be individualized and coordinated with primary care and specialists as appropriate.1
Higher body weight may be associated with HS, but weight is not a diagnostic requirement and HS is not caused by poor hygiene. Weight-focused counseling that eclipses the inflammatory disease can increase shame and delay appropriate treatment.
| Language matters: Prefer: “Some health factors can affect inflammation, and we can address those while also treating the HS.” Avoid: “This will go away if you lose weight” or “You need to wash better.” |
History elements that may change evaluation
- Family history of HS or recurrent boils
- Severe acne, pilonidal disease, or other follicular-occlusion disorders
- Menstrual association, signs of hyperandrogenism, or possible polycystic ovary syndrome when clinically relevant
- Gastrointestinal symptoms such as chronic diarrhea, blood in stool, abdominal pain, poor growth, or perianal disease
- Metabolic risk factors and blood-pressure concerns
- Depression, anxiety, substance use, bullying, and school avoidance