Hidradenitis suppurativa (HS), sometimes called acne inversa, is a chronic inflammatory skin condition. It affects areas where skin rubs together, typically the armpits, groin, and buttocks. HS is characterized by deep-seated nodules, recurring abscesses, and progressive scarring. Because HS is frequently misdiagnosed or diagnosed late, preparing organized information before a consultation is essential. This preparation helps the dermatologist accurately assess disease severity and maximizes the effectiveness of the appointment time.
Preparing Your Medical History and Symptom Log
Before the appointment, compile a comprehensive log of symptoms to provide the dermatologist with a clear baseline of disease activity. This log should detail the frequency and specific location of flares, noting if lesions appear in the armpits, groin, inner thighs, or inframammary folds. Documenting the pain level associated with each flare, often using a 0 to 10 numerical rating scale, helps the provider track the effectiveness of any future treatment plan.
The symptom record should also include the duration of individual lesions, noting how long a nodule persists before it resolves or ruptures. Record any instances of fluid discharge, specifying the color and odor, as this helps differentiate HS lesions from other skin conditions.
Prepare a detailed list of all current medications and supplements for the doctor’s review. This includes any over-the-counter creams, oral antibiotics, or hormonal therapies previously tried for HS or other conditions, along with the results of those treatments. Documenting past treatments that failed is crucial, as this historical data prevents the dermatologist from suggesting ineffective therapeutic options. This thorough documentation accelerates the diagnostic process and helps the provider determine the stage of the disease more quickly.
Communicating the Impact and Severity of HS
During the consultation, describe the physical manifestations of HS to aid in accurate staging. HS lesions begin as deep-seated nodules that can progress to form abscesses that may drain a serosanguinous or purulent fluid. In more advanced stages, the disease creates epithelial-lined tunnels, known as sinus tracts, which connect lesions beneath the skin. These tunnels are a characteristic feature of moderate-to-severe HS and should be pointed out to the doctor, even if they are not actively draining.
The dermatologist uses the Hurley Staging system to classify the disease. This system ranges from Stage I (isolated nodules without tunnels) to Stage III (widespread, interconnected tunnels and extensive scarring). Be honest about all affected body regions, including sensitive areas, as this is necessary for clinical assessment. The presence of irreversible damage, such as thick, rope-like scarring, is a key component of this staging process.
It is equally important to communicate the psychosocial burden of the condition, as this affects treatment goals. Describe how the pain or drainage disrupts daily life, such as limiting mobility or causing sleep interference. Mentioning the impact of HS on work, school attendance, or mental health, including feelings of anxiety or depression, helps the physician understand the overall disease severity. This holistic picture allows the doctor to tailor the treatment plan to address both physical symptoms and quality of life concerns.
Essential Questions About Treatment Options
Once the dermatologist reviews the symptoms and assesses the Hurley stage, the conversation will shift to therapeutic options. Patients should inquire about the spectrum of available treatments:
- Topical Agents: These are used for milder cases, such as clindamycin solution, to reduce bacterial colonization and inflammation.
- Oral Antibiotics: For more widespread disease, ask about combinations like clindamycin and rifampin, which are often used to address underlying inflammation.
- Hormonal Therapies: Women should ask about medications like spironolactone or finasteride, which can be effective due to HS’s link to hormone fluctuations.
- Biologic Medications: If the disease is classified as moderate to severe, ask about systemic treatments like adalimumab, secukinumab, and bimekizumab. These advanced therapies target specific inflammatory pathways, such as TNF-alpha or IL-17, to suppress disease progression.
When discussing any new medication, patients must clarify the expected timeline for results, asking whether improvement should be noticeable in weeks or months. Always ask about the potential side effects and how they will be monitored, especially for systemic drugs that require regular blood work.
Surgical Interventions
If the dermatologist suggests a surgical intervention, ask about the procedure’s goal. Deroofing removes the roof of a tunnel or abscess to allow healing. Wide excision removes the entire affected area and is typically reserved for Hurley Stage II or III disease with extensive tunneling.
Ask whether the proposed treatment is designed primarily to manage acute symptoms or to modify the long-term progression of the disease. For example, a corticosteroid injection may quickly reduce a painful nodule, but it will not prevent future lesions. Understanding the therapeutic mechanism helps set realistic expectations for the outcome of the prescribed plan.
Establishing a Long-Term Care Strategy
Since HS is a chronic condition, establishing a clear plan for continuous management is essential. Ask about the recommended frequency of follow-up appointments, which varies depending on the disease stage and treatment type. It is important to define a protocol for managing acute flares that occur between scheduled visits, including how to contact the office for guidance or prescription adjustments.
Inquire about when the dermatologist would consider a referral to another specialist for multidisciplinary care. For instance, extensive scarring may warrant a consultation with a plastic surgeon for advanced excision techniques. Given the known psychosocial burden of HS, patients should also ask about referrals to a mental health professional. This forward-looking strategy ensures the patient has resources beyond the initial treatment prescription.