New insights into the diagnosis of hidradenitis suppurativa: Clinical presentations and phenotypes - 14/10/15

Doi : 10.1016/j.jaad.2015.07.047

Hessel H. van der Zee, MD ^a,^⁎ , Gregor B.E. Jemec, MD ^b
^a Department of Dermatology, Erasmus Medical Center, Rotterdam, The Netherlands
^b Department of Dermatology, Roskilde Hospital, Health Sciences Faculty, University of Copenhagen, Roskilde, Denmark

^∗Correspondence to: Hessel H. van der Zee, MD, Department of Dermatology, Erasmus Medical Center, Dr Molewaterplein 50, EE-802, Rotterdam 3000 CA, The Netherlands.

Abstract

Current classifications for hidradenitis suppurativa (HS), such as the Hurley staging system, are not very specific. The absence of rigorous classifications is incongruous with the clinical variability of the condition. There is no pathognomonic sign for HS that leads to a diagnosis that is unquestionable. Consequently, diagnosis is made largely through clinical presentation of the condition. The use of several validated tools assists in confirming the diagnosis and the severity of the disease. In future investigations, the identification of phenotypes and clinical subtypes—taking into account genetic variants—will serve to identify subpopulations of patients who are responsive to particular therapies, thereby improving the overall therapeutic picture for patients with HS. There is a potential for personalized, tailored delivery of therapy in the HS setting.

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Key words : clinical subtypes, hidradenitis suppurativa, Hurley staging, inflammatory, noninflammatory, Physician Global Assessment, Sartorius score, severity