Derm Cases · Dermatology / General Surgery / Adolescent Medicine
OSCE — recurrent axilla and groin boils: hidradenitis suppurativa staging and therapy
An 8-minute OSCE station on diagnosing hidradenitis suppurativa, Hurley staging, comorbidity/smoking counselling, medical ladder including antibiotics and biologics, and when to involve surgery.
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Study tools
Target exams
NEET-PGINICETUSMLEPLABMRCP
Prompt
An 8-minute OSCE station on diagnosing hidradenitis suppurativa, Hurley staging, comorbidity/smoking counselling, medical ladder including antibiotics and biologics, and when to involve surgery.
Brief (to candidate)
A 28-year-old woman who smokes has 4 years of recurrent painful nodules, abscesses and double-ended comedones in both axillae and the groin, with rope-like scars. Multiple short antibiotic courses helped only briefly. You have 8 minutes to diagnose, stage, and plan long-term management.
Candidate instructions
- Diagnose hidradenitis suppurativa (acne inversa) and differentiate from recurrent furunculosis.
- Apply Hurley staging (or similar severity framework).
- Screen comorbidities and modifiable risks (smoking, obesity, PCOS, metabolic disease, mood).
- Outline stepwise medical therapy including when biologics are indicated.
- Discuss surgery/drainage limits and shared long-term plan.
Examiner checklist (mark each domain / 10)
| Domain | Key actions expected |
|---|---|
| Recognition | Recurrent inflammatory nodules/abscesses/sinus tracts in intertriginous sites (axilla, groin, inframammary, anogenital); double-ended comedones, scarring; not simple one-off boils[1][4] |
| Staging | Hurley I abscesses without sinus/scar; II recurrent with tracts/scars, separated lesions; III diffuse interconnected tracts across a region |
| Differential | Furunculosis, Crohn fistulae, infected epidermoid cysts, pilonidal disease, granuloma inguinale — chronicity + typical sites + tunnels favour HS |
| Lifestyle & comorbidity | Strongly counsel smoking cessation and weight management; screen metabolic syndrome, PCOS, depression/anxiety, pain disability[1][6] |
| Medical ladder | Topical antiseptics/clindamycin for mild; tetracyclines courses; combination antibiotics for flares; adalimumab (HS-dosed weekly maintenance after loading) or other approved biologics (e.g. IL-17) for moderate–severe refractory disease per guidelines; pain control[6][7] |
| Surgery | I&D only for acute relief — not disease-modifying; consider deroofing/wide excision for persistent tunnels after medical optimisation |
| Communication | Chronic relapsing disease; set expectations; multidisciplinary plan; safety-net rapidly spreading infection/sepsis |
Model key actions
- Diagnose HS from chronic intertriginous nodules/sinuses/scars, not “recurrent boils only”.[1]
- Stage with Hurley, counsel smoking cessation, and escalate to long-term medical/biologic therapy rather than endless short antibiotic bursts.[6][7]
- Use surgery selectively for residual tunnels after medical control.
Common errors
- Repeated I&D only without a disease-modifying plan.
- Ignoring smoking/obesity counselling.
- Confusing with ordinary furunculosis and missing sinus tracts/scars.
- Underusing biologics in extensive Hurley II–III disease.
- Missing depression / sexual health / work disability impact.
References4ShowHide
- [1]Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa: Epidemiology, clinical presentation, and pathogenesis. Journal of the American Academy of Dermatology, 2020.PMID 31604104
- [4]McCarthy S. Hidradenitis Suppurativa. Annual Review of Medicine, 2025.PMID 39869430
- [6]Sabat R, Alavi A, Wolk K, et al. Hidradenitis suppurativa. Lancet, 2025.PMID 39862870
- [7]Zouboulis CC, Bechara FG, Benhadou F, et al. European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment. Journal of the European Academy of Dermatology and Venereology, 2025.PMID 39699926