. Author manuscript; available in PMC: 2022 May 25.

Published in final edited form as: J Am Acad Dermatol. 2019 Mar 11;81(1):76–90. doi: 10.1016/j.jaad.2019.02.067

Table I.

Strength of recommendations for the management and treatment of HS

Recommendations	Strength of recommendation	Level of evidence	References
Grading/classification system
Hurley staging	B	II	¹
HiSCR	A	I	²
HS-PGA	B	II	²
Sartorius	B	II	¹
DLQI	A	I	^1,3,4
Pain VAS	A	I	^1,2,4,5
HSIA	B	II	⁶
HSSA	B	II	⁶
Microbiologic testing	C^*	III	^7-15
Biomarker/genetic testing	Not recommended	III	^7,16-33
Comorbidity screening
Smoking	A	I, II	^34-38
Metabolic syndrome	A	I, II	^34-38
Type II diabetes	A	I, II	^34,35,38-41
Follicular occlusion tetrad	A	II	⁴²
Acne	A	I	⁴³
Depression/anxiety	A	I, II	^{34,35,37,38,44}
Squamous cell carcinoma (of HS-affected skin)	C	II	⁴⁵
Inflammatory bowel disease	A	II	^42,46
Pyoderma gangrenosum and autoinflammatory syndromes^†	B	II	^37,42
Arthropathies^†	B	II	^42,45
Polycystic ovarian syndrome^†	A	I, II	^35,47,48
Impaired sexual health	A	I, II	^49-51
Down syndrome	A	I, II	^52,53
Laser/light therapies
Intense pulsed light	C	III	^54,55
Nd:YAG	B	II	^56-58
Alexandrite	C	III	⁵⁹
Diode	C	III	⁶⁰
CO₂	C	II, III	^61-67
Fractionated CO₂ (for scars)	C	III	^68,69
Photodynamic therapy	C	II, III	^70-77
External beam radiation therapy	C	III	^78,79
Electrosurgery/radiofrequency	C	III	^80,81
Surgical interventions
Wide excision	B	II	^82-87
• Wound closure, secondary intention	C	II	^87-92
• Wound closure, delayed primary closure)	C	II	⁹³
• Wound closure, skin graft	C	II	^89,92,94-96
• Wound closure, flaps	C	II	^{89,94,95,97,98}
• Wound closure, skin substitutes	C	II	⁹⁹
Unroofing/deroofing	B	II	^{84,87,89,100-102}
Laser evaporation	C	II	^66,67,103
CO₂ laser excision	C	II	^63,65
Electrosurgical peeling	C	II	^81,104
Cryosurgery	C	III	^105,106
Abscess drainage	C	II	^{84,89,100,107,108}
Combined medical and surgical treatment	C	II	^109,110
Alternative interventions
Smoking cessation	C	III	^111,112
Zinc	C	II	^113-119
Vitamin D	C	II	¹²⁰
Brewer’s yeast avoidance	C	II	¹²¹
Dairy avoidance	C	III	¹²²
Weight loss	C	II	^{111,119,123-125}
Mechanical irritation (friction, rubbing, compression)	C	III	^126-130
Close shaving avoidance	C	II	^131,132
Wound care
Gentamycin sulfate	C	III	¹³³
Manuka honey	C	III	^134,135
NPWT	C	III	^93,136-145
PRP	C	III	^146,147
Hydrofiber	C	III	^62,64
Silastic dressing	C	III	¹⁴⁸
Pain management
Disease control improves pain	B	II	^149,150
Cautious use of short-acting opiates for acute pain	C	III	¹⁵¹
Management of chronic pain by using WHO pain ladder	C	III	¹⁵¹

Strength of Recommendation Taxonomy recommendation level: I, good-quality patient-oriented evidence; II, limited-quality patient oriented evidence; and III, other evidence, including consensus guidelines, opinion, case studies, or disease-oriented evidence. Evidence grading level: A, recommendation based on consistent and good-quality patient-oriented evidence; B, recommendation based on inconsistent or limited-quality patient-oriented evidence; and C, recommendation based on consensus, opinion, case studies, or disease-oriented evidence.¹⁵²

DLQI, Dermatology Life Quality Index; HiSCR, hidradenitis suppurativa clinical response; HS, hidradenitis suppurativa; HSIA, Hidradenitis Suppurativa Impact Assessment; HS-PGA, Hidradenitis Suppurativa Physician’s Global Assessment; HSSA, Hidradenitis Suppurativa Symptom Assessment; Nd:YAG, neodymium-doped yttrium-aluminum-garnet; NPWT, negative-pressure wound therapy; PRP, platelet-rich plasma; VAS, visual analog scale; WHO, World Health Organization.

Recommended only when infection is in differential or secondary infection is suspected, not in routine care.

^†

Screen only if signs and symptoms present.