Recognition and management of hidradenitis suppurativa in office-based gynecological practices in the Rhine-Main region of Germany: a cross-sectional survey
A cross-sectional survey of 142 gynecological practices in Germany's Rhine-Main region reveals that while most clinicians recognize hidradenitis suppurativa, they inconsistently apply guideline-recommended severity classifications and comprehensive management strategies, highlighting a critical need for targeted education and improved interdisciplinary care pathways.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For many people, a recurring, painful lump in the skin is simply a bad boil or an infection that comes and goes. In the medical world, however, there is a specific, chronic condition called hidradenitis suppurativa. It is a long-term inflammatory disease that affects the skin in areas where it rubs against itself, such as the armpits, groin, and under the breasts. Instead of a single pimple, the condition often creates deep, painful tunnels under the skin that drain fluid and leave behind scars. Because these symptoms can appear in areas a gynecologist routinely examines, doctors in that field are often the first to see the signs. Yet, recognizing the condition is only the first step; knowing how to measure its severity and when to send a patient to a specialist is a more complex challenge that varies widely from one doctor's office to another.
A team of researchers set out to understand how gynecologists in the Rhine-Main region of Germany handle this specific condition. They wanted to know if these doctors could identify the disease, how they assessed its severity, what treatments they started, and whether they checked for other health issues that often travel with it. To find the answers, the researchers sent a survey to every single office-based gynecological practice in that region, a total of 240 clinics. The survey asked about their experience with the disease, their confidence in diagnosing it, the tools they used to measure how bad it was, and how they worked with other specialists like dermatologists. Over the course of several months, from late 2023 to mid-2024, 142 of these practices returned the completed questionnaires, providing a clear picture of current practices in the area.
The results showed that most gynecologists are familiar with the disease. About 86 percent of the responding practices said they knew what hidradenitis suppurativa was, and roughly 71 percent felt confident or very confident in their ability to diagnose it. This is a promising start, as it suggests that the initial recognition of the problem is not the main barrier. However, when the researchers looked deeper into how these doctors managed the condition, a gap appeared between knowing the disease and applying a structured plan. Very few practices, only three out of the 142, used a standard system called the Hurley classification to describe how severe the disease was. Instead, the vast majority, about 87 percent, reported using no recognized scoring system at all. Without a standard way to measure the disease, it becomes difficult to track whether a patient is getting better or worse, or to decide when a treatment needs to change.
When it came to treatment, the doctors in the survey mostly relied on local care, such as applying creams or ointments directly to the skin. About 43 percent of the practices started with local treatment alone. While some doctors did use systemic treatments, which involve medication taken by mouth, this was less common. Interestingly, no practice reported starting a specific type of advanced biologic therapy on their own. This does not necessarily mean patients were missing out on care; rather, it suggests that gynecologists are often acting as the first point of contact and then passing the patient to a specialist for more complex management. The survey also revealed that doctors were not always checking for other health conditions that are known to be linked with this skin disease, such as obesity, diabetes, or hormonal imbalances. Only about 35 percent of the practices reported that they routinely assessed for these associated conditions.
Despite these gaps in standardized assessment, the survey highlighted a strong willingness to work together. Nearly all the practices, about 94 percent, reported that they involved dermatologists in the care of these patients, either as the sole specialist or alongside other doctors. When asked why they referred patients to dermatology, the most common reasons were to get further management of the disease and to start new treatments. The doctors also identified real-world hurdles, such as patients being reluctant to see a specialist or having trouble getting an appointment. Perhaps most significantly, the survey showed a strong desire for more knowledge. About 87 percent of the practices said they wanted more education on how to manage this condition better.
The study concludes that while gynecologists in this region are good at spotting hidradenitis suppurativa, they are not yet using the full toolkit recommended for managing it. They are missing out on standardized ways to measure severity and often overlook the need to check for related health issues. The researchers suggest that the solution lies in targeted education and clear, simple pathways for referring patients to dermatologists. By providing doctors with better training on how to assess the disease and clearer instructions on when to send a patient to a specialist, the medical community can help ensure that patients receive coordinated care sooner. This approach would allow gynecologists to play a more consistent and effective role in the early stages of treatment, bridging the gap between initial recognition and comprehensive management.
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