Updated Canadian guidelines on management of hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease that is characterized by the formation of comedones, papules, nodules, abscesses and sinus tracts in the axillary, inframammary, groin and gluteal areas (areas with a high density of apocrine sweat glands). It typically presents in adolescents and young adults, and is more common in females. HS affects up to 3.8% of the Canadian population. Many patients are initially misdiagnosed and do not receive adequate treatment early on, due to a lack of awareness of this disease. Recent studies indicate that many HS patients visit multiple different healthcare providers over an average of seven years before being diagnosed. HS can progress in severity if left untreated, leading to chronic pain, reduced mobility and a poor overall quality of life. Read: Developing an effective management plan for patients with HS can be challenging. In 2020, a survey found that 61% of patients with HS were not satisfied with current treatment options after previously trying an average of 15 different therapies. A combination of different treatment modalities may be necessary to achieve disease control. It is important to be aware of comorbidities that commonly occur with HS to help guide treatment decisions. The updated Canadian clinical guidelines on HS management review the following topics: Diagnosis and assessment of HS severity Comorbidities associated with HS (inflammatory bowel disease, polycystic ovarian syndrome, diabetes, thyroid disease, inflammatory arthritis, obesity, metabolic syndrome, acne, pyoderma gangrenosum, anemia, depression and anxiety) Medical complications of HS (squamous cell carcinoma) Lifestyle modifications (avoiding potential triggers, smoking cessation, exercise, choice of clothing, hair removal and menstrual products, dietary modification, supplements) Medical treatments (topical skin cleansers, topical resorcinol, topical antibiotics, topical retinoids, oral contraceptives, spironolactone, finasteride, metformin, oral antibiotics, oral retinoids, intralesional corticosteroid injections, botulinum toxin injections, laser hair removal, photodynamic therapy, biologics, other immunomodulatory agents) Pain management, surgical management and wound care. The guidelines also include the following helpful tables/figures: Summary of an approach to history-taking, initial assessment and management of HS Algorithm outlining a stage-specific approach to HS management Summary of topical treatments Summary of oral hormonal and antihyperglycemic therapies Summary of oral and intravenous antibiotics used to treat HS Summary of first-, second- and third-line biologic agents used to treat HS. Patients should be advised that multiple lifestyle, medical and surgical interventions may be needed to achieve disease control. Treatment plans should be individualized. Reference 1. Johnston LA, Alhusayen R, Bourcier M. Practical guidelines for managing patients with hidradenitis suppurativa: an update. J Cutan Med Surg 2022; published online August 24, 2022. (accessed September 6, 2022)

Updated Canadian guidelines on management of hidradenitis suppurativa

Register for free access or login.

Related Topics