Australasian hidradenitis suppurativa management guidelines

Abstract

Hidradenitis Suppurativa is a burdensome inflammatory skin disease with significant quality of life impact. These management guidelines were developed to direct appropriate clinical management in the Australasian context. A systematic review was used for the basis of the consensus guidelines. Thirteen clinical experts were involved in a modified Delphi consensus process to develop the guidelines and treatment algorithms. Overall management strategies include appropriate severity assessment of disease and comorbidities, multimodal therapy with systemic and local treatments, and evidence-based progression along the therapeutic ladder in the event of inadequate response. Sequential monotherapy with antibiotics and/or single agent therapy is discouraged and aggressive treatment of moderate to severe disease to capture the window of opportunity is highly emphasised. Specific considerations in the setting of disease comorbidities, pregnancy and breastfeeding are also addressed. Overall, the complex nature of HS requires a complex and multimodal therapeutic response with medical, physical and surgical therapies to achieve best patient outcomes.

Keywords: acne Inversa; consensus; guidelines; hidradenitis suppurativa.

FIGURE 1

A schematic representation of the four major tenets of Hidradenitis Suppurativa management. Treatment under all four aspects are required to optimise disease control.

FIGURE 2

Overall medical management guidelines for Hidradenitis Suppurativa. Baseline disease severity stratification and assessment for appropriate comorbidities should be undertaken with first line therapy determined by the underlying disease activity.

FIGURE 3

Management of HS during pregnancy and the post partum period: Disease activity commonly flares during pregnancy and consideration to the safety of medications for both mother and foetus are required. Disease optimisation at each stage is required, however, decisions regarding continuation of biologic therapy are based upon a risk–benefit assessment between patient and provider.