Primary Care Teleconsultations in Hidradenitis Suppurativa: Characteristics and Clinical Decision-Making

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease in which diagnosis and treatment may modify the course. Teleconsultation (TC) between primary care (PC) and dermatology can expedite referrals. We aimed to (1) assess PC recognition of HS using TC free-text terminology and its impact and (2) determine concordance between TC and in-person evaluation in staging (Hurley, International HS Severity Score System [IHS4]) and treatment.

Cross-sectional study of patients referred via TC to a hospital HS unit (May 2024-May 2025). A blinded HS expert reviewed narratives, assigned Hurley stage, calculated IHS4, and proposed graded treatment (topical, oral antibiotic, biologic). Agreement with in-person assessment (examination ± ultrasound [US]) was analyzed using weighted Cohen's kappa (κ), Bland-Altman plots, and paired t tests.

One hundred patients were included (mean age 37.9 ± 14.4 years; 53% women). "Hidradenitis suppurativa" appeared in 57% of TCs; omission correlated with inflammatory nodules, Hurley I, and atypical or inguinogenital phenotypes. TC underestimated severity: 57% (25/44) of in-person Hurley II were graded as Hurley I in TC; mean TC-IHS4 was lower than in-person IHS4 (3.9 vs. 6.4; mean difference +2.5; p < 0.001). TC-based treatment matched in 50%, was more intensive in 27%, and less intensive in 23%.

Half of PC referrals omit the HS label, in mild or atypical forms. TC tends to underestimate severity and yields 50% therapeutic concordance, risking under- or overtreatment. Strengthening PC education and combining TC with physical examination and US may improve HS care.