Proposed Definitions of Typical Lesions in Hidradenitis Suppurativa

Abstract

Background: Although not rare, hidradenitis suppurativa (HS) is often under-recognized by physicians. The diagnosis of HS is clinical via the recognition of lesions typical of the disease, but universally accepted definitions of these latter are currently lacking, which means that certain severity scores employed for HS classification/management are used differently by different physicians. Our aim was to develop a set of descriptive definitions and associated images of HS lesions, in order to enable doctors to better recognize and evaluate the disease. Methods: MEDLINE-available literature and dermatological textbooks on HS morphology were retrieved (January 1996 to February 2016). A preliminary set of definitions of HS typical lesions was created, including 10 terms. Each term was associated with a pathophysiological classification and an image. This preliminary set was shown during the 5th Conference of the European HS Foundation (EHSF). The physicians attending the event were invited to vote on each term and make comments via a voting sheet. Results: A total of 81 physicians answered the questionnaire. Their agreement/disagreement rates and comments were used to obtain a revised set of definitions and images. Pathophysiological classifications were dropped. Conclusion: A user-friendly set of definitions/images of HS typical lesions was proposed and will need to be validated by further studies. This set could ultimately serve as a tool to better recognize, score, and assess treatment efficacy.

Real-Time Confocal Imaging for Hidradenitis Suppurativa: Description of Morphological Aspects and Focus on the Role of Follicular Ostia

“…Open comedos observed by RCM in patients with acne [11] showed similar morphological aspects compared to HS open comedos of our sample, with comparable infundibular diameter (376 µm in the former and 294 µm in the latter), content of the cavity, and aspects characterizing edges. We examined open comedos as they represent typical HS lesions, commonly seen in HS patients, conversely to close comedos that are not seen in HS but in acne [22]. According to a recent hypothesis, this observation could be likely explained by the main involvement of sebaceous glands occurring in acne that affects body sites with the highest sebaceous gland density [12].…”

The Genomic Architecture of Hidradenitis Suppurativa—A Systematic Review

“…Notwithstanding, the limited number of studies investigating HS by whole exome sequencing, and to a lesser extent by whole genome sequencing, show promising results and highlight the need for patients at the extreme ends of the HS phenotypic spectrum to be identified and prioritized for rare variant screening. To this end, phenotypic evaluation and categorization criteria need to be standardized to facilitate their use and interpretation in clinical care settings ( Daxhelet et al, 2020 ; Frew et al, 2021 ).…”

Practical Guidelines for Managing Patients With Hidradenitis Suppurativa: An Update

“…Three diagnostic criteria must be met in order to diagnose HS: (1) characteristic lesion morphology (2) characteristic distribution of lesions (3) chronicity and recurrence (Table 1). 12,13 If a patient meets all three diagnostic criteria, there is a 90% sensitivity and 97% specificity for a correct diagnosis of HS. 13,14…”