Swiss Practice Recommendations for the Management of Hidradenitis Suppurativa/Acne Inversa

Abstract

Hidradenitis suppurativa (HS) is a painful, inflammatory, debilitating skin disease with a chronic intermittent course. The central pathogenetic event seems to be the occlusion of the hair follicle. HS has a 1-year prevalence of about 1%. It typically presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body: most commonly the axillae, inguinal, and anogenital regions. HS has a high negative impact on patients' quality of life even in patients with only limited disease burden, and the diagnosis of HS is often made with a long diagnostic delay. In this practical short version we present diagnostic and therapeutic recommendations which are based on a systematic literature search as well as an informal expert consensus of Swiss dermatologists and dermatosurgeons.

Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization – systematic review and recommendations from the HS ALLIANCE working group

“…The HS ALLIANCE recommendations in this review largely agree with the current clinical practice guidelines in Europe, suggesting similar approaches for first‐ and second‐line medical and surgical treatment options (Appendix ; comparison of current recommendations). The German guidelines and the recent Swiss and Canadian guidance incorporated existing evidence and practitioners’ expertise into a framework for the evaluation and treatment of patients with HS, in a non‐systematic fashion. Nonetheless, the discussed medical and surgical therapies align with those in the European S1 guidance, albeit with a greater focus on hormonal and laser therapies in Canada.…”

Hidradenitis Suppurativa Associated with Down Syndrome Is Characterized by Early Age at Diagnosis

“…Clinically, typical lesions are painful, deep-seated, inflamed nodules and abscesses, sinus tracts, and scarring, located on the body areas rich in apocrine glands such as the axillae, inguinal, and anogenital regions. The onset of signs and symptoms occurs between puberty and 40 years of age, with a peak between the second and third decade of life [2]. Women are more likely to be affected (female:male ratio is 2–5: 1) but men tend to have a more severe disease [2, 5].…”

“…The onset of signs and symptoms occurs between puberty and 40 years of age, with a peak between the second and third decade of life [2]. Women are more likely to be affected (female:male ratio is 2–5: 1) but men tend to have a more severe disease [2, 5]. Although the pathogenesis is complex and not yet clear, genetic susceptibility, mechanical stress, obesity, smoking, and hormonal factors are recognized risk factors associated with the development or worsening of HS [6, 7].…”

Hidradenitis Suppurativa is a Diagnosis to be Discussed

“…It is pleasing that these confirm the initial cases presented and therefore offer many patients hope for better control of their disease. Guidelines have been established both nationally, e.g., in Switzerland and Germany [13, 14], as well as internationally [15]. In spite of these improvements, patients still experience an unmet need for treatment, and so cases remain a valuable source of new ideas [16].…”