Hidden in Plain Sight: Strategies to Improve Early Identification of Hidradenitis Suppurativa

EP: 1.Recognizing Hidradenitis Suppurativa: From First Signs to an Accurate Diagnosis

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EP: 2.Hidden in Plain Sight: Strategies to Improve Early Identification of Hidradenitis Suppurativa

Delays in diagnosing hidradenitis suppurativa (HS) are often driven by misidentification of its hallmark symptoms—painful, recurrent boils and abscesses—as more common conditions like bacterial infections, ingrown hairs, or even sexually transmitted diseases. These misdiagnoses can lead to repeated, unnecessary treatments such as incision and drainage or prolonged antibiotic use, which fail to address the underlying chronic inflammation of HS. The result is not only ineffective treatment but also increased risk of antibiotic resistance and worsening disease. Because these lesions often appear in sensitive or hidden areas like the armpits or groin, both patients and clinicians may avoid discussing them, compounding the likelihood of delayed recognition.

HS has been described as a disease “hidden in plain sight.” Patients may cycle through multiple health care settings—urgent care, primary care, or emergency departments—without receiving a correct diagnosis, as no single provider connects the pattern of recurrent symptoms. To improve early detection, it’s essential for health care systems to implement strategies that flag repeat visits for abscesses or nonhealing lesions. Clinical decision support tools embedded in electronic health records can help prompt providers to screen for HS when recurrent presentations occur. Furthermore, provider education is critical. Many clinicians are simply not trained to recognize HS, particularly if they’ve had limited exposure to dermatologic diseases during training or practice.

Ongoing education and awareness-building efforts are vital to reducing diagnostic delays. Initiatives such as continuing medical education programs, disease awareness campaigns, and collaborations with rare disease organizations can help providers stay informed. Embedding clinical pathways and creating multidisciplinary care teams that include dermatologists, pharmacists, and nurses ensures a more cohesive, timely approach to HS management. When health care professionals from different specialties are trained to recognize HS and coordinate care, it improves the likelihood of early diagnosis and more effective, individualized treatment—ultimately leading to better outcomes for patients.