European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment
- PMID: 39699926
- PMCID: PMC12023723
- DOI: 10.1111/jdv.20472
European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment
Abstract
Introduction: This second part of the S2k guidelines is an update of the 2015 S1 European guidelines.
Objective: These guidelines aim to provide an accepted decision aid for the selection, implementation and assessment of appropriate and sufficient therapy for patients with hidradenitis suppurativa/acne inversa (HS).
Methods: The chapters have been selected after a Delphi procedure among the experts/authors. Certain passages have been adopted without changes from the previous version. Potential treatment complications are not included, being beyond the scope of these guidelines.
Results: Since the S1 guidelines publication, validation of new therapeutic approaches has almost completely overhauled the knowledge in the field of HS treatment. Inflammatory nodules/abscesses/draining tunnels are the primary lesions, which enable the classification of the disease severity by new validated tools. In relation to the degree of detectable inflammation, HS is classified into the inflammatory and the predominantly non-inflammatory forms. While the intensity of the inflammatory form can be subdivided by the IHS4 classification in mild, moderate and severe HS and is treated by medication accordingly, the decision on surgical treatment of the predominantly non-inflammatory form is based on the Hurley stage of the affected localization. The effectiveness of oral tetracyclines as an alternative to the oral combination of clindamycin/rifampicin should be noted. The duration of systemic antibiotic therapy can be shortened by a 5-day intravenous clindamycin treatment. Adalimumab, secukinumab and bimekizumab subcutaneous administration has been approved by the EMA for the treatment of moderate-to-severe HS. Various surgical procedures are available for the predominantly non-inflammatory form of the disease. The combination of a medical therapy to reduce inflammation with a surgical procedure to remove irreversible tissue damage is currently considered a holistic therapeutic approach.
Conclusions: Suitable therapeutic options while considering HS severity in the therapeutic algorithm according to standardized criteria are aimed at ensuring a proper therapy.
© 2024 The Author(s). Journal of the European Academy of Dermatology and Venereology published by John Wiley & Sons Ltd on behalf of European Academy of Dermatology and Venereology.
Conflict of interest statement
CCZ has received advisory board and consultancy fees from Almirall, Boehringer Ingelheim, Eli Lilly, Idorsia, Incyte, L'OREAL, MSD, NAOS‐BIODERMA, Novartis, Pfizer, PPM, Sanofi and UCB, and lecture honoraria from Almirall, Amgen, Biogen, Novartis, Pfizer and UCB. His departments have received grants from Astra Zeneca, Boehringer Ingelheim, the Brandenburg Medical School Theodor Fontane, the EADV, the European Union, the German Federal Ministry of Education and Research, GSK, Inflarx, MSD, Novartis, Relaxera and UCB for his participation as clinical and research investigator. He is the president of the EHSF e.V., coordinator of the ALLOCATE Skin group of the ERN Skin and chair of the ARHS Task Force group of the EADV. He is the editor of the EADV News and co‐copyright holder of IHS4 on behalf of the EHSF e.V. FGB has received honoraria for participation in advisory boards, in clinical trials, and/or as a speaker from AbbVie, Acelyrin, Boehringer Ingelheim, Celltrion, Dr. Wolff, Incyte, Inflarx, Janssen, Merck, Mölnlycke, Moonlake, Novartis, Sanofi, Sitala and UCB. VB has acted as consultant, advisory board member, research investigator and received honoraria from AbbVie, Avene, Beiersdorf, Bioderma, Biogena, Difa‐Cooper, Exeltis, Galderma, Ganassini, Giuliani, GSK, ICF, Isdin, Leo Pharma, L'OREAL, Meda, Menarini–Relife, Mylan, Novartis, Pharcos‐Biodue, Pierre‐Fabre and UCB. His institution has received research support from AbbVie. VDM has participated as clinical investigator for AbbVie, Amgen, Boehringer Ingelheim, BMS, Incyte, Leo Pharma, Novartis, Pfizer, Sanofi, UCB. Her department received grants from Almirall, BMS and Sanofi. She is the president of the Belgian Society of Dermatology, board member of the ESPCR and EDF, and chair of the EADV‐PPRC committee and the Euromelanoma skin cancer prevention campaign for Europe. EJG‐B reports honoraria and consultation fees from Abbott Products Operations, bioMérieux, Brahms GmbH, GSK and Sobi (granted to the National and Kapodistrian University of Athens); independent educational grants from AbbVie, InCyte, Novartis and UCB (granted to the National and Kapodistrian University of Athens) and from Abbott Products Operations, bioMérieux Inc., Johnson & Johnson, MSD and Swedish Orphan Biovitrum AB (granted to the Hellenic Institute for the Study of Sepsis), support for attending the HS guidelines meeting from the EHSF e.V., and funding from the Horizon 2020 European Grants ImmunoSep and RISCinCOVID and the Horizon Health grants EPIC‐CROWN‐2 and POINT (granted to the Hellenic Institute for the Study of Sepsis). MD‐V has received lecture honoraria from AbbVie, Novartis and SwixxBioPharma. PG has received advisory board and consultancy fees and support for attending meetings from AbbVie, Cicaplus, Inresa, Novartis and UCB. REH has received lecture honoraria from AbbVie, Galderma, Novartis, Sandoz and UCB. BH has received advisory board and consultancy fees from AbbVie, Akari, Argenx, Janssen, Novartis, Regeneron, Roche, Sanofi, UCB and HS studies support from Akari and Janssen. JRI has received advisory board fees, lecture honoraria and support for attending meetings from Abbvie, Boehringer Ingelheim, ChemoCentryx, Citryll, Insmed, Kymera, MoonLake, Novartis, UCB, UNION and Viela Bio. He is a co‐copyright holder of HiSQoL, Investigator Global Assessment and Patient Global Assessment instruments for HS. His department receives income from copyright of the Dermatology Life Quality Index and related instruments. He is officer of the British Association of Dermatologists 2019–2024 and has received a stipend as Editor‐in‐Chief of the British Journal of Dermatology 2019–2024 and an ongoing authorship honorarium from UpToDate. DI reports honoraria for lectures and fees for consultation of AbbVie, Amgen, Genesis, Jannsen, Leo Pharma, Novartis, Pfizer, Sanofi and UCB (granted to the Aristotle University of Thessaloniki). He is treasurer and committee chair of the EADV and board member of the Hellenic Society of Dermatology and Venereology. EJ has received consultancy fees from Novartis and support for attending meetings from the EHSF e.V. and Novartis. LK has received advisory board fees from AbbVie, BMS, Eli Lilly, Novartis, Pfizer, Sanofi, UCB, consultancy fees from AbbVie, Amgen, Boehringer Ingelheim, BMS, Incyte, Leo Pharma, Novartis, Pfizer, Sanofi, UCB, lecture honoraria from AbbVie, BMS, Eli Lilly, Novartis, Pfizer, Sanofi and UCB, and support for attending meetings from AbbVie, Novartis and Sanofi. BK has received advisory board and consultancy fees from Abbvie, Almirall, Amgen, BMS, Celgene, Eli Lilly, GSK, Janssen, Leo Pharma, MC2 Therapeutics, Moonlake, Novartis, Pfizer, UCB, Union and has participated at a Data Safety Monitoring Board of Arctic Bioscience. He has received lecture honoraria from Abbvie, Almirall, BMS, Celgene, Eli Lilly, Janssen, Leo Pharma, MC2 Therapeutics, Moonlake, Novartis and UCB, and support for attending meetings from. Abbvie, Almirall, BMS, Eli Lilly, Janssen, Moonlake, Novartis, UCB and Union. AIL has received advisory board fees from Novartis, lecture honoraria and support for attending meetings from AbbVie, Boehringer Ingelheim Novartis, UCB Pharma. She is sub‐investigator in clinical trials of AbbVie, Boehringer Ingelheim, Insmed, Novartis, Sanofi and UCB. His institution has received grants from Abbvie, Almirall, the British Skin Foundation, the City of Dublin Skin and Cancer Charity, the Irish Research Council, Janssen, Moonlake, Novartis, the Science Foundation Ireland and UCB for his participation as clinical and research investigator. He is member of the EHSF e.V. scientific committee, steering committee BADBIR and interim chair of the Dermatology Clinical Advisory Group, Ireland. AVM has received advisory board and consultancy fees, disease‐relevant lecture honoraria and support for attending meetings from AbbVie, Amgen, Boehringer Ingelheim, BMS, Incyte, Leo Pharma, Novartis, Pfizer, Sanofi, UCB. BMMG has received consultancy fees, honoraria and support for attending meetings from Novartis and UCB, and consultancy fees from Incyte. ŁM has received advisory board and consultancy fees from AbbVie, Leo Pharma, Novartis and UCB, and lecture honoraria from Almirall, AbbVie, Aristo Pharma, Janssen, Leo Pharma, Medac, Novartis, Pfizer, Pierre‐Fabre, La Roche‐Posay and UCB. He obtained support for attending meetings from AbbVie and Novartis and was investigator of RCT of AbbVie, Almirall, Amgen, AnaptysBio, BMS, Boehringer Ingelheim, Celltrion, Galderma, Helm, Incyte, InfraRX, Janssen, Kliniksa, Leo Pharma, Medimmune, Menlo, Merck, Novartis, Pfizer, Regeneron, Takeda, Teva, Trevi and UCB. He is a member of the Polish Dermatology Society Guideline Committee for HS. AM‐L has received advisory board fees, lecture honoraria and support for attending meetings from Abbvie, Almirall, Amgen, Novartis and UCB. MP has received advisory board fees from AbbVie, Boehringer Ingelheim, CSL, Galderma, Janssen, MoonLake, Novartis, L'OREAL and UCB, and consultancy fees from AbbVie, CSL, Galderma, Janssen, Novartis and UCB. He has obtained lecture honoraria and support for attending meetings from AbbVie, Beiersdorf, BMS, Eli Lilly, Galderma, Janssen, Leo Pharma, L'OREAL, Novartis, MSD and UCB. EPP has received consultancy fees from GSK, Janssen, MSD, Novartis, UCB and lecture honoraria from Janssen and UCB. FP has received advisory board and consultancy fees from AbbVie, Amgen, Almirall, BMS, Boehringer Ingelheim, Eli Lilly, Leo Pharma, Novartis, Pfizer, Sanofi, Takeda and UCB, and lecture honoraria from AbbVie, Amgen, Biogen, BMS, Böhringer‐Ingelheim, Eli Lilly, Leo Pharma, Novartis, Sanofi and UCB. MR has received advisory board and consultancy fees from AbbVie, BMS, Eli Lilly, Janssen and Sanofi. DMLS has received advisory board and consultancy fees from Novartis, Sanofi and UCB, and lecture honoraria from Jamjoom Pharma, Leo Pharma, Novartis, Sanofi and UCB. She obtained support for attending meetings from Novartis, Pfizer and Sanofi. She has received support for the present manuscript from Novartis und UCB. She is EADV Board Member, Chair of the Danish Dermatology Society Guideline Committee for HS, and Section Editor of Dermatology and the JEADV. JCS has received consultancy fees from AbbVie, Almirall, Galderma, Leo Pharma, Novartis, Pfizer, Sanofi‐Genzyme, Trevi, Vifor, Sandoz and UCB, and lecture honoraria from AbbVie, Almirall, Janssen, Eli Lilly, Leo Pharma, Novartis, Pfizer, Sanofi‐Genzyme, Novartis, Teva and UCB. He obtained support for attending meetings from Leo Pharma, Novartis, Sanofi‐Genzyme and UCB and has participated as clinical investigator for AbbVie, Aceleryn, Almirall, Amgen, AnaptysBio, Argenx, ASLAN, Biocom, Biogen, Bio‐Thera, BMS, Boehringer Ingelheim, Celtrion, CuraTeQ, DICE, Galapagos, Galderma, Helm AG, Incyte, InfraRX, Janssen, Kliniksa, Leo Pharma, Medimmune, Menlo Therapeutics, Merck, Moonlake, Novartis, Pfizer, Regeneron, Takeda, Teva, Trevi, UCB, Uni Therapeutics and Ventyx. He is president of the Polish Dermatological Society. TT has received advisory board and consultancy fees and lecture honoraria from Abbvie, Almirall, Boehringer Ingelheim, Novartis, Pfizer and UCB. He is the treasurer of the EHSF e.V. and EADV executive committee member. SV has received advisory board fees, lecture honoraria and support for attending meetings from Abbvie, Amgen, Johnson & Johnson, Leo Pharma, Novartis, Pfizer, Roche and Sanofi. She is principal investigator and sub‐investigator in clinical trial of Boehringer Ingelheim and Novartis. HHvdZ has received consultancy fees and lecture honoraria from Abbvie, Incyte, InflaRx, Insmed, Novartis and UCB. KRvS has received consultancy fees and lecture honoraria from Novartis and UCB. AS has received advisory board, consultancy fees and lecture honoraria from AbbVie, Eli Lilly, Janssen, Novartis, Pfizer, Sanofi and UCB. She obtained support for attending meetings from AbbVie, Janssen and UCB. She is board member of European Society of Dermatological Research and member of the Editorial Board of JEADV. GBEJ has served as a consultant for AbbVie, Coloplast, InflaRx, Leo Pharma, Novartis and UCB, and on advisory boards for AbbVie, Janssen, MSD, Novartis, UCB and as a speaker for AbbVie, Coloplast, Galderma and Leo Pharma. He has served as an investigator for AbbVie, InflaRx, Leo Pharma, Novartis, Regeneron and UCB, and has received unrestricted grants from AbbVie, Leo Pharma and Novartis. He is a vice president of the EHSF e.V. FB, ØG, ZBM, AN, HR and BV declare no conflict of interest.
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