Hidradenitis Suppurativa- Diagnosis, Evaluation and that Use of Complementary and Procedural Management
Publication Date: July 1, 2019
Last Updated: March 14, 2022
Recommendations
Grading and Classification
Clinical performance, Hurley staging, and inflammatory lesion counts (abscesses and inflammatory lesions) are recommended.
Consider clinically following pain VAS and DLQI.
The recommended grading systems in research studies are the HiSCR, HS-PGA, Sartorius score, DLQI, and pain VAS; the HSIA and HSSA can also be considered.
Consider clinically following pain VAS and DLQI.
The recommended grading systems in research studies are the HiSCR, HS-PGA, Sartorius score, DLQI, and pain VAS; the HSIA and HSSA can also be considered.
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Screening for Comorbidities
Perform a review of systems and a physical examination to screen for metabolic syndrome, depression, anxiety, diabetes, PCOS, and tobacco abuse.
Refer patients with additional risk factors for diabetes such as obesity, hypertension, hyperlipidemia, and acanthosis nigricans for HbA1c and/or fasting glucose testing.
Screen for depression, inflammatory bowel disease, autoinflammatory syndromes, and inflammatory arthropathy based on review of systems.
Refer patients with additional risk factors for diabetes such as obesity, hypertension, hyperlipidemia, and acanthosis nigricans for HbA1c and/or fasting glucose testing.
Screen for depression, inflammatory bowel disease, autoinflammatory syndromes, and inflammatory arthropathy based on review of systems.
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Lifestyle Modifications and Alternative Treatments
Counsel smoking cessation.
Screen for obesity and counsel weight loss.
May recommend oral zinc supplements (weak evidence).
Insufficient evidence exists to recommend avoidance of dairy or brewer’s yeast, vitamin D supplementation, avoidance of friction, deodorant, and depilation/shaving.
Screen for obesity and counsel weight loss.
May recommend oral zinc supplements (weak evidence).
Insufficient evidence exists to recommend avoidance of dairy or brewer’s yeast, vitamin D supplementation, avoidance of friction, deodorant, and depilation/shaving.
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Surgical Modalities
Recurrent nodules and tunnels may be best treated with deroofing or excision. Incision and drainage is recommended only for acute abscesses to relieve pain.
Wide local scalpel, CO2, or electrosurgical excision (with or without reconstruction) is appropriate for extensive chronic lesions.
Wound healing following surgery may be through secondary intention, primary closure, delayed primary closure, flaps, grafts, and/or skin substitutes.
Experience suggests that continuing medical therapy in the perioperative period is likely to be beneficial and poses minimal risk of increased postoperative complications.
Wide local scalpel, CO2, or electrosurgical excision (with or without reconstruction) is appropriate for extensive chronic lesions.
Wound healing following surgery may be through secondary intention, primary closure, delayed primary closure, flaps, grafts, and/or skin substitutes.
Experience suggests that continuing medical therapy in the perioperative period is likely to be beneficial and poses minimal risk of increased postoperative complications.
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Pain Management
Pain management in HS starts with disease control.
The multidimensional aspects of pain should be considered when dealing with pain management.
In select cases of severe pain, use of individualized, carefully prescribed short-acting opioid analgesics may be needed.
Recommend that chronic pain be managed according to the World Health Organization pain ladder.
The multidimensional aspects of pain should be considered when dealing with pain management.
In select cases of severe pain, use of individualized, carefully prescribed short-acting opioid analgesics may be needed.
Recommend that chronic pain be managed according to the World Health Organization pain ladder.
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Light, Laser, and Energy SSources
An Nd:YAG laser is recommended in patients with Hurley stage II or /III disease on the basis RCT and case series data and in patients with Hurley stage I disease on the basis of expert consensus.
Other wavelengths that are used for follicular destruction are recommended on the basis of lower-quality evidence.
CO2 laser excision is recommended in patients with Hurley stage II or III disease with fibrotic sinus tracts.
External beam radiation and PDT have a limited role in the management of patients with HS.
Other wavelengths that are used for follicular destruction are recommended on the basis of lower-quality evidence.
CO2 laser excision is recommended in patients with Hurley stage II or III disease with fibrotic sinus tracts.
External beam radiation and PDT have a limited role in the management of patients with HS.
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Recommendation Grading
Overview
Title
Hidradenitis Suppurativa- Diagnosis, Evaluation and that Use of Complementary and Procedural Management
Authoring Organization
Hidradenitis Suppurativa Foundation
Publication Month/Year
July 1, 2019
Last Updated Month/Year
January 31, 2024
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory
Intended Users
Physician, nurse, nurse practitioner, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Diseases/Conditions (MeSH)
D017497 - Hidradenitis Suppurativa
Keywords
adalimumab, infliximab, clindamycin, spironolactone, laser photocoagulation, ertapenem, comorbidities, Hidradenitis suppurativa, acne inversa, carbon dioxide laser, Nd:YAG, oral contraceptive pills, finasteride
Methodology
Number of Source Documents
211
Literature Search Start Date
March 16, 2017
Literature Search End Date
December 1, 2018