EARLY DIAGNOSIS OF HIDRADENITIS SUPPURATIVA IN PRIMARY CARE: WARNING SIGNS, DIFFERENTIAL DIAGNOSIS, AND REFERRAL PATHWAY
Keywords:
hidradenitis suppurativa; primary care; early diagnosis; differential diagnosis; referral; ultrasound; inflammatory skin diseaseAbstract
DOI: https://doi.org/10.46296/yc.v10i19.0974
Abstract
Background: Hidradenitis suppurativa (HS) is a chronic inflammatory follicular disease characterized by painful nodules, abscesses, draining tunnels, and scarring in intertriginous areas. Diagnostic delay promotes irreversible structural damage and substantial physical and psychosocial burden. Objective: To summarize clinical criteria for early HS diagnosis in primary care, identify warning signs and relevant differential diagnoses, and propose a tiered referral pathway based on severity, location, and complexity. Evidence sources: A structured narrative review of PubMed/MEDLINE and official journal and scientific-society sources was performed, prioritizing international guidelines, consensus statements, systematic reviews, and primary-care studies published from January 2020 through August 31, 2026, together with seminal diagnostic and severity-classification studies. Synthesis: Diagnosis relies on three pillars: compatible morphology, typical distribution, and recurrence/chronicity. Two or more episodes within six months in intertriginous sites provide a practical recognition threshold. Draining tunnels, scarring, multisite disease, moderate-to-severe IHS4, major quality-of-life impact, and inadequate control in primary care justify prioritized dermatology referral. Systemic toxicity suggesting deep infection, complex perianal disease with gastrointestinal symptoms, atypical or non-healing chronic lesions, and suicidal risk warrant accelerated condition-specific pathways. Routine bacterial cultures do not establish HS. High-frequency ultrasound can define subclinical extent, whereas magnetic resonance imaging is particularly valuable in complex perianal or deep disease. Conclusion: Pattern recognition, brief severity assessment, and structured warning-sign triage can shorten time to diagnosis and facilitate timely referral before inflammatory disease progresses to permanent tunnels and scars.
Keywords: hidradenitis suppurativa; primary care; early diagnosis; differential diagnosis; referral; ultrasound; inflammatory skin disease.
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