North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations

Abstract

Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of

Hidradenitis Suppurativa: Current Understanding of Pathogenic Mechanisms and Suggestion for Treatment Algorithm

“…HS management is often complex. The standard of care management requires an individualized approach in a multifaceted approach, ranging from self-management (e.g., avoidance of skin trauma, pain management, smoking cessation, weight loss and hygiene practices) to local therapies, systemic antibiotics, and a wide range of immunomodulating agents, as well as surgical interventions such as excisional and laser surgeries (6,15,38,39,60). Additionally, the diagnosis and management of medical comorbidities and referral to psychiatrist might be taken into consideration (61).…”

“…Local treatment of this chronic disorder includes antiseptic washes, keratolytic agents and topical antibiotics (6,60). Selection of dressing is based on the location, skin condition, amount of drainage, cost and patient preference (6,60).…”

“…Local treatment of this chronic disorder includes antiseptic washes, keratolytic agents and topical antibiotics (6,60). Selection of dressing is based on the location, skin condition, amount of drainage, cost and patient preference (6,60). For local treatment of selected large open wounds, use of negative-pressure therapy for a short period of time (1-4 weeks) followed by delayed reconstruction might be effective (6).…”

“…For local treatment of selected large open wounds, use of negative-pressure therapy for a short period of time (1-4 weeks) followed by delayed reconstruction might be effective (6). Clinical experience supported the use of Intralesional corticosteroid injection (e.g., triamcinolone 3-5 mg) only for short-term control of acute and recalcitrant HS lesions (60,65). Pain is typically reduced fast and a reduction in edema, erythema, suppuration and lesion size occur after a few days.…”

“…Determining the frequency and duration of antibiotic use should balance of antibiotic use vs. potential harms associated with antibiotic resistance, because findings of recent studies stated that antibiotic therapy for HS treatment might be inducing antibiotic resistance (67). Typically, HS recurs following cessation of antibiotic therapy, making repeated or long-term treatments necessary, with all their potential harmful side effects (60). For Hurley stage I-II, especially in the absence of abscesses, topical clindamycin 1% is a possible therapy (60,66,68,69).…”