European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa

Abstract

Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually 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. A mean disease incidence of 6.0 per 100,000 person-years and an average prevalence of 1% has been reported in Europe. HS has the highest impact on patients' quality of life among all assessed dermatological diseases. HS is associated with a variety of concomitant and secondary diseases, such as obesity, metabolic syndrome, inflammatory bowel disease, e.g. Crohn's disease, spondyloarthropathy, follicular occlusion syndrome and other hyperergic diseases. The central pathogenic event in HS is believed to be the occlusion of the upper part of the hair follicle leading to a perifollicular lympho-histiocytic inflammation. A highly significant association between the prevalence of HS and current smoking (Odds ratio 12.55) and overweight (Odds ratio 1.1 for each body mass index unit) has been documented. The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity. Locally recurring lesions can be treated by classical surgery or LASER techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus rifampicine, tetracyclines), acitretin and biologics (adalimumab, infliximab). A Hurley severity grade-relevant treatment of HS is recommended by the expert group following a treatment algorithm. Adjuvant measurements, such as pain management, treatment of superinfections, weight loss and tobacco abstinence have to be considered.

Adalimumab for Treating Moderate-to-Severe Hidradenitis Suppurativa: An Evidence Review Group Perspective of a NICE Single Technology Appraisal

“…Alongside lifestyle changes (smoking cessation and weight loss), therapeutic options include topical antiseptics and antibiotics, systemic antibiotics (e.g. oral tetracyclines, clindamycin and rifampicin), anti-androgens, systemic retinoids, immunomodulatory agents, laser treatment, surgery and tumour necrosis factor-alpha (TNF-) inhibitors [11][12][13]. Treatment choices typically depend on the frequency, severity and spread of lesions and also gender in the case of the retinoid acitretin.…”

Hidradenitis Suppurativa in General Practice: A Pilot Study

“…HS is often associated with an impaired quality of life [1,2]. HS is histologically characterized by chronic follicular hyperkeratosis and its pathophysiology is not yet fully understood, but it likely includes an interaction between a complex genetic background and the effect of external factors [3].…”

“…(1) Typical lesions, i.e., deep-seated painful nodules: 'blind boils' in early lesions; abscesses, draining sinus, bridged scars and 'tombstone' double-ended pseudocomedones in secondary lesions (2) Typical topography, i.e., axillae, groins, perineal and perianal region, buttocks, infra and inter mammary folds (3) Chronicity and recurrences All three criteria must be met for establishing the diagnosis The diagnosis has to be discussed when the recurrence of the lesions is more than 2 times/6 months [3].…”

Recurrent Acute Hidradenitis Suppurativa: Case Report With 12 Month Follow Up.

“…The axillary and inguinoperineal regions are most commonly affected. In this patient Multiple open comedones and so-called bridged comedones are the hallmark finding of hidradenitis suppurativa; they frequently progress to multiple abscesses and sinus tract formations [1] . When 2 distant cutaneous orifices are interconnected through a subcutaneous fistula, they form bridging lesions.…”