Topic 2: Inflammation and Damage Are Related—but Not Identical
Inflammatory activity is dynamic: nodules, abscesses, drainage, pain, and flare frequency can change over weeks. Structural damage is cumulative and may persist after active inflammation settles. A patient can therefore have substantial current inflammation without tunnels, or relatively few active lesions with meaningful pre-existing tunnels and scars.
Current mechanistic models describe HS as an immune-mediated inflammatory disease rather than a recurrent infection, supporting treatment strategies that address sustained inflammation.7
| Domain | What the clinician may observe or hear | Why it matters |
| Current inflammation | Tender nodules, abscesses, drainage, pain, new lesions | Signals active disease requiring control now |
| Inflammatory pattern | Frequent flares, short intervals without disease, multiregional activity | Shows burden that a single examination may miss |
| Structural damage | Tunnels, bridged or contractile scars, restricted movement | May be irreversible and can require procedural as well as medical management |
| Patient burden | Sleep disruption, work or school loss, difficulty sitting or exercising, distress | May justify proactive management even when lesion counts appear modest |