Table I.
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.