A number of other lesions may be seen in patients with HS. Some of these lesions are clearly follicular and may therefore obscure HS lesions and cause a delay in the diagnosis. Common small follicular papules and pustules are frequent in area in both early and late HS (see Fig. 3.11) and may occur isolated in a region not involved by HS [1, 2]. The general prevalence of minor pustular follicular lesions of the skin in not known, but such transient lesions are estimated to be very common. In HS patients such lesions are not uncommon on the buttocks, but they do not constitute a diagnostic clue for HS (see Fig. 3.12). Other common findings are the circular depressed superficial scars also sometimes observed on the buttocks of patients. These are most likely secondary to the unspe-cific elements, and are not a clue for the diagnosis of HS.
In a subgroup of patients, however, cysts occur as a prominent associated finding. These cysts are either white, round 1- to 2-cm smooth elastic cysts grouped in flexural areas, or large
Fig. 3.11. Folliculitis close to HS
Fig. 3.10. Comedones, black heads in burnt-out lesions
Fig. 3.13. Epidermal (epithelial) cyst
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