Hidradenitis suppurativa: information for the treating clinician

Hidradenitis suppurativa: information for the treating clinician

This page is written for the clinician side of an HS Care Card, not for patients. It summarizes current emergency-medicine literature on hidradenitis suppurativa; it is not a treatment protocol, and it does not replace independent clinical assessment of the patient in front of you.

If you are a patient looking for your own information, see this site's general guidance on when to seek medical help instead. About the HS Care Card

What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS, also Acne Inversa) is a chronic, immune-mediated inflammatory skin disease that typically affects the axillae, groin and inframammary regions, producing recurrent painful nodules, abscess-like lesions, sinus tracts, drainage and scarring (Okun et al., J Emerg Med 2022).

Why patients with HS present acutely

Patients with HS frequently present to emergency departments or urgent care for acute pain and drainage. In a multinational survey, 18.3% reported five or more emergency-department visits for HS symptoms, and 61.4% rated recent HS-related pain as moderate or higher (Garg et al., J Am Acad Dermatol 2019). Access to dermatology was rated difficult by 37.0%.

A retrospective cohort study of 20,269 patients with HS found a high rate of repeat emergency-department visits alongside comparatively low dermatology follow-up, and the authors identify this as an opportunity for better cross-specialty connection to care (Wang et al., JAMA Dermatol 2022).

Distinguishing HS from infection

HS lesions can closely resemble a localized skin or soft-tissue infection, and current emergency-medicine literature explicitly describes this differentiation as a clinical challenge (Okun et al., J Emerg Med 2022; Reddy et al., Am J Emerg Med 2024). An acute HS flare can also present with systemic inflammatory signs such as fever, which can mimic a severe soft-tissue infection.

A known, long-standing HS pattern in the same body site supports the underlying diagnosis, but does not replace clinical assessment of the current presentation. This card does not make that determination — it only presents what the patient reports about their own HS and their usual pattern.

Acute treatment and long-term disease control

Emergency treatment of acute symptoms — pain relief, wound care, or a procedure where clinically indicated — does not replace long-term dermatologic management of HS as a chronic disease. Conversely, a patient's existing dermatologic treatment does not replace independent assessment of today's presentation.

Transition back to HS care

Because dermatology follow-up after an emergency-department visit for HS is documented as uncommon, prompting the patient to follow up promptly with an existing dermatology clinician — or referring them where no such clinician exists — may help reduce repeat acute-care visits (Wang et al., JAMA Dermatol 2022; Klufas et al., Emerg Med J 2025).