Acne Inversa Diagnosis: How Does It Work?

Written by Dr. rer. nat. Dennis Alexander Kwiatkowski

The Short Answer

Acne inversa is usually diagnosed clinically. This means that medical professionals listen to your history, examine the skin and look out for a typical pattern.

A single blood test does not prove HS. Three questions are particularly decisive: Which lesions occur, where do they occur and do they keep coming back?

1. The Medical History

The conversation is not only about the current spot. Typical questions are:

• How long have the symptoms been present?
• Which areas of the body are affected?
• How often do nodules, abscesses or weeping areas recur?
• Do scars, hardened areas or recurring openings remain?
• Which treatments or diagnoses have there been so far?

Pain, sleep, movement, work and feelings of shame are also part of the history, because they show how strongly the symptoms affect everyday life.

2. The Examination

During the examination, the focus is on which skin changes are currently visible. These may include deep nodules, abscesses, weeping areas, scars or tunnels (sinus tracts).

The location helps with the assessment. Typical regions are the armpits, groin, genital and perineal region, buttocks and the skin folds under the breast. Other causes remain possible nonetheless.

3. The Clinical Assessment

HS becomes more likely when typical lesions in typical locations come together with a chronic or recurring course. This is precisely why the question “How often has this happened before?” is so important.

Depending on the findings, it is also checked which other explanations might fit, for example boils, folliculitis, inflamed cysts, acne or a pilonidal sinus.

4. Additional Tests, When They Make Sense

Not every appointment requires the same tests. Depending on the situation, swabs, laboratory values, imaging or further specialist assessment may be helpful. Such steps can better classify complications, accompanying conditions or other causes.

However, they do not replace the clinical assessment of the disease course.

5. What You Can Prepare

A brief overview often helps more than a perfect wording:

1. Note the body areas and how often symptoms occur.
2. Bring photos of active spots, if available.
3. Gather earlier treatments, procedures and diagnoses.
4. Openly address scars, discharge, concerns about odour and pain.
5. Write down questions that you do not want to forget during the appointment.

If not everything is resolved at the first appointment, that is not a failure. A good diagnosis emerges from examination, the course of the disease and a conversation that takes the recurring pattern seriously.