Severity and Therapeutic Decisions Based on Lesion Location in Patients With Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease for which several phenotypic classifications have been proposed in recent years to optimize medical care. The aim of this study was to define a new classification of HS based on the anatomical distribution of lesions, serving as a tool for therapeutic decision-making.

This cross-sectional study with consecutive sampling included patients attending their first medical consultation at the Hidradenitis Suppurativa Unit of Virgen de las Nieves University Hospital in Granada, Spain, between January 1, 2017, and March 1, 2024. Patients were classified into four groups based on the anatomical distribution of HS: Upper, Atypical, Lower, and Progressor HS. Sociodemographic variables, personal history, and HS-related variables were collected.

A total of 557 patients were included, with a similar proportion of men and women. Patients with the Upper type exhibited milder forms of HS and underwent surgical treatment more frequently. In contrast, those with the Progressor type presented more severe forms of HS and required more immunomodulatory treatment. Patients in the Atypical and Lower groups showed more heterogeneity in therapeutic approaches, although the presence of lesions in specific locations may help predict the need for early initiation of more aggressive treatments.

We propose a new HS classification based on the location of lesions. This classification can be used alone or in conjunction with previous ones to identify patients at higher risk of progression and to guide therapeutic decision-making.