Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology

Abstract

Hidradenitis suppurativa is a chronic immune mediated disease of universal distribution that causes great damage to the quality of life of the affected individual, whose prevalence is estimated at 0.41% in the Brazilian population. The objective of this work was update on physiopathogenesis, diagnosis and classification of hidradenitis suppurativa and to establish therapeutic recommendations in the Brazilian reality. It was organized as a work group composed of eight dermatologists from several institutions of the country with experience in the treatment of hidradenitis suppurativa and carried out review on the topic. Recommendations were elaborated and voted by modified Delphi system and statistical analysis of the results was performed. The Brazilian consensus on the clinical approach of hidradenitis suppurativa had the support of the Brazilian Society of Dermatology.

A Comparison of International Management Guidelines for Hidradenitis Suppurativa

“…Nine guidelines (including one 2-part publication) meeting the inclusion and exclusion criteria were selected (Table 1, presented in chronological order of publication). These guidelines have been established by working groups and organizations including the British Association of Dermatologists [18], US and Canadian HS Foundations [19, 20], HS ALLIANCE (international expert group from Europe and North America) [21], Canadian Dermatology Association [22, 23], European HS Foundation [24], European Academy of Dermatology and Venereology [25], Swiss consensus group [26], and Brazilian Society of Dermatology [27].…”

“…Hurley staging is universally recommended across guidelines as a tool for clinical grading of baseline HS severity [18, 19, 21-27]. Hurley staging classifies HS clinical severity as Hurley stage I for single or multiple abscesses without scarring, Hurley stage II for limited scarring and/or sinus tracts, and Hurley stage III for extensive scarring and/or sinus tracts [28].…”

“…Screening for comorbidities is discussed in all except the Canadian Dermatology Association guidelines [18, 19, 21, 23-27]. Common comorbidities cited are cardiovascular disease, diabetes mellitus, metabolic syndrome, autoimmune conditions (especially inflammatory bowel disease and inflammatory arthropathies), polycystic ovary syndrome, depression, and anxiety.…”

Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley stage 1 hidradenitis suppurativa: prospective short-term trial and 1-year follow-up in 28 consecutive patients

“…HS treatment guidelines advise to use topical clindamycin or oral tetracycline in HS and, in case of failure, recommend the rifampicin-clindamycin association 1,[7][8][9] . However, only two small randomized trials assessed the efficacy of antibiotics (oral tetracycline and topical clindamycin) in HS and only demonstrated a slight and temporary improvement 21,22 .…”

“…In order to obtain some relief, continuous or repeated intermittent empirical antibiotic treatments are used to treat 54 to 88% HS patients [3][4][5][6] with various combinations, uncertain efficacy and a potential risk of antibiotic resistance emergence. Antibiotics are considered as first line treatment for HS 1,[7][8][9] but prospective data are limited.…”