Table 1:

Summary of major international hidradenitis suppurativa pain management guidelines

Guideline	Recommendation statements	Specific therapies
US and Canadian HS Foundations25,a (2019)	Disease control improves pain (B, II) Pain VAS is a recommended grading system in clinic and research studies (A, I) The multidimensional aspects of pain should be considered in pain management WHO pain ladder for chronic pain (C, III)	Acute Pain: I&D recommended only for acute abscesses to relieve pain. Topical lidocaine, oral acetaminophen, and oral NSAIDs Cautious short-acting opiates for acute pain (C, III) Chronic pain: WHO Pain Ladder: Codeine, hydrocodone, morphine Anticonvulsants: pregabalin and gabapentin
British Association of Dermatologists21,b (2019)	Measure treatment response using recognized instruments for pain such as VAS or NRS (GPP) Treat pain if needed (GPP)	Consider ILT for individual HS lesions during acute phase (↑)
HS ALLIANCE24,c (2019)	PROs including pain and itching should be included HS assessment (C, IV)	I&D for acute, tense, painful lesions (C, IV)
Brazilian Society of Dermatology23 (2019)	One objective of treatment is to improve QoL, with special attention to pain and discharge	ILT 5–10mg/mL for acute inflammation and abscesses I&D strictly for symptom relief in acute abscess
Canadian Dermatology Association22 (2018)	No mention of pain management	None
Canadian Consensus Guidelines19 (2017)	Pain is one of the most debilitating features of HS and needs to be managed Routine use of PROs including pain assessment (VAS) is strongly recommended As a general guideline, clinicians should follow WHO pain ladder119 Prescribing pain medications is beyond the scope of usual dermatologic practice and underscores the need for multidisciplinary management	ILT 5–10 mg/mL for acute flares and non-responsive nodules and sinus tracts
Swiss Guidelines20 (2017)	No mention of pain management	None
European HS Foundation18,d (2016)	All patients should be offered adjuvant pain therapy as needed Strongly recommend routine use of PROs including pain assessment (VAS) HS pain is important and should be measured and managed appropriately A multidisciplinary approach is preferable	NSAIDs (D, IV) Opioids (D, IV) Corticosteroids, intralesional and systemic (D, IV)
European S1 Guidelines17 (2015)	See specific therapies	NSAIDS: Recommend naproxen. Avoid –coxibs (cardiovascular risk) Topical ketoprofen may be used in lieu of oral NSAID Opioids: Suggest codeine and hydrocodone as first line.

↑: Weak recommendation for the use of an intervention; GPP: Good Practice Point, derived from informal consensus;²¹ HS: hidradenitis suppurativa; I&D: incision and drainage; ILT: intralesional triamcinolone; NRS: numeric rating scale; NSAIDs: nonsteroidal anti-inflammatory drugs; PRO: patient-reported outcomes; QoL: quality of life; VAS: visual analogue scale; WHO: World Health Organization

^aRecommendation level and evidence grade according to Strength of recommendation taxonomy (SORT);¹²⁰

^bRecommendations according to British Association of Dermatologists adoption of GRADE methodology;¹²¹

^cLevels of Evidence and Grades of Recommendation according to Oxford Centre for Evidence-based Medicine;¹²²

^dRecommendations based on GRADE methodology;¹²³