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Diagnosis of HS
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An expert physician assistant in dermatology provides an overview of how HS is diagnosed, and how the diagnosis is often delayed.
Gina Mangin, MPAS, PA-C: HS [hidradenitis suppurativa] is diagnosed by a clinical diagnosis, so patients will be evaluated by a physician, a PA [physician assistant], or a nurse practitioner, and on evaluation you will notice nodules, abscess, tombstone comedones—these are pairs of comedones adjacent to each other—and you can have hypertrophic or fibrous scarring. It’s a clinical diagnosis. When these patients present with 2 or more recurrent lesions within a 6-month span, that’s when you start thinking HS.
So, many times HS is diagnosed, or I should say there’s a delay in diagnosis, and the delay can range somewhere from 7 to 10 years. Now, the question is, why is there such a delay in diagnosis? Part of the problem is these patients are given wrong diagnoses as having plain abscesses, cellulitis, or folliculitis. Often, these patients, on average, have seen 5 medical providers before the correct diagnosis is made. Also playing a role is that 75% of the time, these patients think that this disease or these symptoms they’re having will go away on their own, and that may delay them coming in to be evaluated. Now, how can we improve on the delay of the diagnosis for these individuals? Education is key; educating our colleagues and patients about the signs and symptoms of HS. I feel in the past 2 years there has been a little bit more buzz about HS, and I have been seeing more patients come into my office knowing or thinking that they have this diagnosis because they’ve already seen some information on the internet or they’ve heard some information from friends and family. The buzz is starting, but we must continue that momentum.
Transcript edited for clarity
