Topic 7: Recognize When Referral Should Not Wait

The 2025 North American guideline for special populations provides pediatric treatment recommendations but also reflects the limited pediatric-specific evidence base. For non-dermatologists, the key action is to recognize HS, address immediate needs, and connect patients with longitudinal expertise before disease becomes more structurally advanced or disabling.⁷

Consider timely dermatology referral when:

• The diagnosis is uncertain or lesions recur in characteristic locations
• There is scarring, a draining or nondraining tunnel, tissue distortion, or restricted movement
• Flares are frequent, persistent, multiregional, or inadequately controlled
• Pain, drainage, school absence, sleep disturbance, or psychosocial burden is clinically meaningful
• Initial treatment has not produced sustained control
• Systemic, hormonal, biologic, or procedural treatment may need consideration
• Comorbid inflammatory bowel disease, severe acne, polycystic ovary syndrome, metabolic disease, or significant mental-health concerns require coordinated care