Guidelines for the Management of Patients with Hidradenitis Suppurativa

Authors

  • Joana Cabete Serviço de Dermatovenereologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa.
  • Inês Aparício Martins Serviço de Dermatovenereologia. Hospital de Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa.

DOI:

https://doi.org/10.20344/amp.18916

Keywords:

Hidradenitis Suppurativa/diagnosis, Hidradenitis Suppurativa/surgery, Hidradenitis Suppurativa/therapy

Abstract

Hidradenitis suppurativa is a chronic and recurrent inflammatory dermatosis characterized by the presence of inflammatory nodules and abscesses in the apocrine gland-rich areas that may progress to suppurative fistulas and scars. Despite being considered one of the dermatological conditions with the greatest impact on patient quality of life, it is often underdiagnosed. Hidradenitis suppurativa, especially in its severe forms, is associated with numerous comorbidities, so a holistic and multidisciplinary perspective is crucial for the management of these patients. The therapeutic approach is complex and challenging. The medical treatment options are diverse and must be adapted to clinical presentation and disease severity. Surgical therapy should be considered as an adjuvant to medical treatment, particularly in refractory cases and in the presence of scars or anatomical and/or functional mutilation. These recommendations reflect the main aspects of the management of the patient with hidradenitis suppurativa and are addressed to all healthcare professionals who take part in their follow-up.

Downloads

Download data is not yet available.

References

Zouboulis CC, Benhadou F, Byrd AS, Chandran NS, Giamarellos-Bourboulis EJ, Fabbrocini G, et al. What causes hidradenitis suppurativa? - 15 years after. Exp Dermatol. 2020;29:1154–70. DOI: https://doi.org/10.1111/exd.14214

Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29:619–44. DOI: https://doi.org/10.1111/jdv.12966

Revuz JE, Jemec GB. Diagnosing hidradenitis suppurativa. Dermatol Clin. 2016;34:1–5. DOI: https://doi.org/10.1016/j.det.2015.08.009

Sabat R, Jemec GB, Matusiak Ł, Kimball AB, Prens E, Wolk K. Hidradenitis suppurativa. Nat Rev Dis Primers. 2020;6:18. DOI: https://doi.org/10.1038/s41572-020-0149-1

Matusiak Ł, Bieniek A, Szepietowski JC. Hidradenitis suppurativa and associated factors: still unsolved problems. J Am Acad Dermatol. 2009;61:362–5. DOI: https://doi.org/10.1016/j.jaad.2009.03.043

Smith MK, Nicholson CL, Parks-Miller A, Hamzavi IH. Hidradenitis suppurativa: an update on connecting the tracts. F1000Res. 2017;6:1272. DOI: https://doi.org/10.12688/f1000research.11337.1

Hoffman L, Ghias M, Lowes M. Pathophysiology of hidradenitis suppurativa. Semin Cutan Med Surg. 2017;36:47–54. DOI: https://doi.org/10.12788/j.sder.2017.017

Garg A, Neuren E, Cha D, Kirby JS, Ingram JR, Jemec GB, et al. Evaluating patients’ unmet needs in hidradenitis suppurativa: results from the Global Survey Of Impact and Healthcare Needs (VOICE) Project. J Am Acad Dermatol. 2020;82:366–76. DOI: https://doi.org/10.1016/j.jaad.2019.06.1301

Basra MK, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol. 2008;159:997–1035. DOI: https://doi.org/10.1111/j.1365-2133.2008.08832.x

Nguyen TV, Damiani G, Orenstein LA, Hamzavi I, Jemec GB. Hidradenitis suppurativa: an update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. J Eur Acad Dermatol Venereol. 2021;35:50–61. DOI: https://doi.org/10.1111/jdv.16677

Balieva F, Kupfer J, Lien L, Gieler U, Finlay AY, Tomás-Aragonés L, et al. The burden of common skin diseases assessed with the EQ5DTM: a European multicentre study in 13 countries. Br J Dermatol. 2017;176:1170–8. DOI: https://doi.org/10.1111/bjd.15280

Tzellos T, Yang H, Mu F, Calimlim B, Signorovitch J. Impact of hidradenitis suppurativa on work loss, indirect costs and income. Br J Dermatol. 2019;181:147–54. DOI: https://doi.org/10.1111/bjd.17101

Saunte DM, Boer J, Stratigos A, Szepietowski JC, Hamzavi I, Kim KH, et al. Diagnostic delay in hidradenitis suppurativa is a global problem. Br J Dermatol. 2015;173:1546–9. DOI: https://doi.org/10.1111/bjd.14038

Loget J, Saint-Martin C, Guillem P, Kanagaratnam L, Becherel PA, Nassif A, et al. Errance médicale des patients atteints d’hidradénite suppurée: un problème majeur et persistant. Étude « R-ENS Verneuil ». Ann Dermatol Venereol. 2018;145:331–8. DOI: https://doi.org/10.1016/j.annder.2018.01.043

Kokolakis G, Wolk K, Schneider-Burrus S, Kalus S, Barbus S, Gomis-Kleindienst S, et al. Delayed diagnosis of hidradenitis suppurativa and its effect on patients and healthcare system. Dermatology. 2020;236:421–30. DOI: https://doi.org/10.1159/000508787

Marzano AV, Genovese G, Casazza G, Moltrasio C, Dapavo P, Micali G, et al. Evidence for a ‘window of opportunity’ in hidradenitis suppurativa treated with adalimumab: a retrospective, real-life multicentre cohort study*. Br J Dermatol. 2021;184:133–40. DOI: https://doi.org/10.1111/bjd.18983

Martorell A, Caballero A, González Lama Y, Jiménez-Gallo D, Lázaro Serrano M, Miranda J, et al. Manejo del paciente con hidradenitis supurativa. Actas Dermosifiliogr. 2016;107:32–42. DOI: https://doi.org/10.1016/S0001-7310(17)30007-8

Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T. Evidencebased approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord. 2016;17:343–51. DOI: https://doi.org/10.1007/s11154-016-9328-5

Dauden E, Lazaro P, Aguilar MD, Blasco AJ, Suarez C, Marin I, et al. Recommendations for the management of comorbidity in hidradenitis suppurativa. J Eur Acad Dermatol Venereol. 2018;32:129–44. DOI: https://doi.org/10.1111/jdv.14517

Garg A, Malviya N, Strunk A, Wright S, Alavi A, Alhusayen R, et al. Comorbidity screening in hidradenitis suppurativa: evidence-based recommendations from the US and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2022;86:1092–101. DOI: https://doi.org/10.1016/j.jaad.2021.01.059

Zouboulis CC, Bechara FG, Dickinson-Blok JL, Gulliver W, Horváth B, Hughes R, et al. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization – systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol. 2019;33:19–31. DOI: https://doi.org/10.1111/jdv.15233

Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2019;81:91–101. DOI: https://doi.org/10.1016/j.jaad.2019.02.068

Ingram JR, Collier F, Brown D, Burton T, Burton J, Chin MF, et al. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol. 2019;180:1009–17. DOI: https://doi.org/10.1111/bjd.17537

Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations. J Am Acad Dermatol. 2019;81:76–90. DOI: https://doi.org/10.1016/j.jaad.2019.02.067

Bassas-Vila J, González Lama Y. Hidradenitis supurativa y enfermedad de Crohn perianal: diagnóstico diferencial. Actas Dermosifiliogr. 2016;107:27–31. DOI: https://doi.org/10.1016/S0001-7310(17)30006-6

Savage KT, Singh V, Patel ZS, Yannuzzi CA, McKenzie-Brown AM, Lowes MA, et al. Pain management in hidradenitis suppurativa and a proposed treatment algorithm. J Am Acad Dermatol. 2021;85:187–99. DOI: https://doi.org/10.1016/j.jaad.2020.09.039

Zouboulis CC, Tzellos T, Kyrgidis A, Jemec GB, Bechara FG, Giamarellos-Bourboulis EJ, et al. Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity. Br J Dermatol. 2017;177:1401–9. DOI: https://doi.org/10.1111/bjd.15748

Kimball AB, Jemec GB, Yang M, Kageleiry A, Signorovitch JE, Okun MM, et al. Assessing the validity, responsiveness and meaningfulness of the Hidradenitis Suppurativa Clinical Response (HiSCR) as the clinical endpoint for hidradenitis suppurativa treatment. Br J Dermatol. 2014;171:1434–42. DOI: https://doi.org/10.1111/bjd.13270

Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210–6. DOI: https://doi.org/10.1111/j.1365-2230.1994.tb01167.x

Direção-Geral da Saúde. A dor como 5o sinal vital. Registo sistemático da intensidade da dor. Circular normativa: Ministério da Saúde No09/DGCG de 2003. Lisboa: DGS; 2003.

Martorell A, Segura Palacios JM. Ecografía de la hidradenitis supurativa. Actas Dermosifiliogr. 2015;106:S49–59. DOI: https://doi.org/10.1016/S0001-7310(16)30007-2

Martorell A, Alfageme Roldán F, Vilarrasa Rull E, Ruiz-Villaverde R, Romaní De Gabriel J, García Martínez F, et al. Ultrasound as a diagnostic and management tool in hidradenitis suppurativa patients: a multicentre study. J Eur Acad Dermatol Venereol. 2019;33:2137-42. DOI: https://doi.org/10.1111/jdv.15710

Hendricks AJ, Hsiao JL, Lowes MA, Shi VY. A comparison of international management guidelines for hidradenitis suppurativa. Dermatology. 2021;237:81–96. DOI: https://doi.org/10.1159/000503605

Orenstein LA, Nguyen TV, Damiani G, Sayed C, Jemec GB, Hamzavi I. Medical and surgical management of hidradenitis suppurativa: a review of international treatment guidelines and implementation in general dermatology practice. Dermatology. 2020;236:393–412. DOI: https://doi.org/10.1159/000507323

Molinelli E, Brisigotti V, Simonetti O, Campanati A, Sapigni C, D’Agostino GM, et al. Efficacy and safety of topical resorcinol 15% as long-term treatment of mild-to-moderate hidradenitis suppurativa: a valid alternative to clindamycin in the panorama of antibiotic resistance. Br J Dermatol. 2020;183:1117–9. DOI: https://doi.org/10.1111/bjd.19337

van Straalen KR, Tzellos T, Guillem P, Benhadou F, Cuenca-Barrales C, Daxhelet M, et al. The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: results of a prospective European cohort study. J Am Acad Dermatol. 2021;85:369–78. DOI: https://doi.org/10.1016/j.jaad.2020.12.089

Marasca C, Tranchini P, Marino V, Annunziata MC, Napolitano M, Fattore D, et al. The pharmacology of antibiotic therapy in hidradenitis suppurativa. Expert Rev Clin Pharmacol. 2020;13:521–30. DOI: https://doi.org/10.1080/17512433.2020.1762571

Delaunay J, Villani AP, Guillem P, Tristan A, Boibieux A, Jullien D. Oral ofloxacin and clindamycin as an alternative to the classic rifampicin–clindamycin in hidradenitis suppurativa: retrospective analysis of 65 patients. Br J Dermatol. 2018;178:e15–6. DOI: https://doi.org/10.1111/bjd.15739

Rabindranathnambi A, Jeevankumar B. Dapsone in hidradenitis suppurativa: a systematic review. Dermatol Ther. 2022;12:285–93. DOI: https://doi.org/10.1007/s13555-021-00674-x

Goldburg SR, Strober BE, Payette MJ. Hidradenitis suppurativa. J Am Acad Dermatol. 2020;82:1061–82. DOI: https://doi.org/10.1016/j.jaad.2019.08.089

Poli F, Revuz J. «Poussées inflammatoires d’acné» sous isotrétinoïne révélant une hidradénite suppurée: 4 cas. Ann Dermatol Venereol. 2019;146:4–8. DOI: https://doi.org/10.1016/j.annder.2018.07.020

Choi E, Ooi XT, Chandran NS. Hidradenitis suppurativa in pediatric patients. J Am Acad Dermatol. 2022;86:140–7. DOI: https://doi.org/10.1016/j.jaad.2020.08.045

Chellappan B, Nguyen DD, Hoyer P, Ross L. Dermatologic management of hidradenitis suppurativa and impact on pregnancy and breastfeeding. Cutis. 2022;109:160–2. DOI: https://doi.org/10.12788/cutis.0480

Bechara FG, Hessam S. Hidradenitis suppurativa. MMW Fortschr Med. 2016;158:52–3. DOI: https://doi.org/10.1007/s15006-016-8662-6

Shanmugam VK, Mulani S, McNish S, Harris S, Buescher T, Amdur R. Longitudinal observational study of hidradenitis suppurativa: impact of surgical intervention with adjunctive biologic therapy. Int J Dermatol. 2018;57:62–9. DOI: https://doi.org/10.1111/ijd.13798

Published

2023-02-01

How to Cite

1.
Cabete J, Aparício Martins I. Guidelines for the Management of Patients with Hidradenitis Suppurativa. Acta Med Port [Internet]. 2023 Feb. 1 [cited 2024 Dec. 23];36(2):133-9. Available from: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/18916

Issue

Section

Guidelines