Hidradenitis suppurativa: US, Canadian Foundations issue guidelines

  • J Am Acad Dermatol

  • Brian Richardson, PhD
  • Clinical Essentials
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Takeaway

  • The US and Canadian Hidradenitis Suppurativa Foundations have released clinical management guidelines for the diagnosis, evaluation, and management of hidradenitis suppurative (HS).

Why this matters

  • Understanding and treatment of HS is evolving rapidly, and current HS management strategies use variable activity and outcome measures.

Key recommendations

  • Clinical performance Hurley staging and inflammatory lesion counts are recommended for grading and classification.
  • Screening for metabolic syndrome, depression, anxiety, diabetes, polycystic ovary syndrome, and tobacco abuse is recommended.
  • Recurrent nodules and tunnels may be treated with deroofing or excision; incision and drainage is recommended only for acute abscesses to relive pain; and wide local scalpel, CO2, or electrosurgical excision is appropriate for extensive chronic lesions.
  • Individualized, carefully prescribed short-acting opioid analgesics may be needed in select cases of severe pain.
  • Nd:YAG laser is recommended in Hurley stage II/III patients based on RCT and case series data and in Hurley stage I diseases based on expert consensus, whereas CO2 laser excision is recommended in Hurley II/III patients with fibrotic sinus tracts.

Study design

  • Guidelines were based on a primary literature review concluded on March 16, 2017, and selected updates of high clinical impact through December 1, 2018.
  • Funding: None.