HS is usually diagnosed by your doctor on the basis of your symptoms and examination of your skin. But if the doctor is not sure whether your condition is HS or something else, they might do a skin biopsy to help them decide.

A biopsy is where a sample of skin is taken from an area affected by HS after first making the skin numb with an injection of local anaesthetic.

The skin sample is then looked at under a microscope to decide if you have HS.

It is sometimes difficult for doctors to accurately diagnose HS, especially if you haven’t had it for long. So people who have HS are often initially misdiagnosed with another condition by mistake.

You might initially be diagnosed with conditions such as:

• folliculitis (inflammation of the hair follicles)
• boils
• granuloma inguinale (a sexually transmitted disease)
• scrofuloderma (tuberculosis of the skin)
• Crohn’s disease (an inflammatory condition of the bowel with some skin manifestations).

If you have boils mainly in areas of your body other than your groin or armpits, you are unlikely to have HS.

Doctors use a specific definition to help them accurately diagnose HS.⁵ It involves having typical lesions, the characteristic distribution, and the recurring nature over time.

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