Dealing with skin conditions like acne or psoriasis can be hard enough when you know what you’re working with. But some maladies come with the additional challenge of a tricky diagnosis process to begin with, potentially sending you on a wild goose chase of treating inconsequential symptoms or, even worse, a misdiagnosis that only makes matters worse.
Hidradenitis suppurativa is one such condition. A chronic, autoinflammatory skin disease, it borrows symptoms from a range of other common skin issues. It’s typically found in areas where skin folds onto itself, such as the armpits or groin, and symptoms can include boils, abscesses, drainage, and even scarring. And the longer it runs untreated, the worse it can get, making life increasingly uncomfortable and awkward for the afflicted.
Similar to acne, hidradenitis suppurativa initiates at the hair follicle. Except, unlike acne, which tends to express outward, much of hidradenitis suppurativa’s activity happens beneath the skin—which makes sense, given the condition’s alias: acne inversa (as in, inverted acne). “It’s not just the follicle, but also the associated sweat gland. And those glands are what allow this larger, deeper, more inflammatory process.,” says Nicole Lee, MD, MPH, FAAD, board-certified dermatologist and owner of Epoch Dermatology.
“Oftentimes, people will come in with recurring abscesses or infection. You’ll treat them, and yet they keep getting recurrences of it in specific areas. That triggers you to think that this is more than just an isolated event,” says Dr. Lee.
While there’s some data to suggest the cause of hidradenitis suppurativa could be linked with variables like increased visceral fat and smoking, dermatologists told GQ that it is most likely genetic, with these environmental factors simply helping to stimulate the condition’s progression.
“Most importantly, and I really emphasize this to patients, is that this is not hygiene related,” says Gibran Shaikh, MD, board-certified dermatologist and clinical instructor in the Department of Dermatology at Mount Sinai. “A lot of times, people go to the emergency department and they’re told, ‘Oh you have a boil, you need to wash yourself or shower more.’ This is not that.”
Turns out, misdiagnoses are pretty common in cases of hidradenitis suppurativa. Here’s why.
It shares some of the same symptoms as other common skin conditions
One of the most frequent complications in diagnosing hidradenitis suppurativa is that it gets mistaken for other conditions. Up until the point of eventual scarring, the condition’s unequivocal calling card, it presents mostly as a collection of symptoms that may not even appear to be related to one another.
