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Requests for reprints should be addressed to Amit Garg, MD, Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY 11042.
Hidradenitis suppurativa is a chronic, progressive inflammatory disease of the skin with many systemic implications. Hidradenitis suppurativa is frequently underdiagnosed or misdiagnosed, particularly because of heterogeneity in presentation and low disease recognition. Patients can see multiple types of health care providers, including primary care providers, along their journey to an accurate diagnosis. This review provides a comprehensive overview of the clinical presentation, associated comorbidities, and life impact associated with hidradenitis suppurativa. Disease features described here can facilitate earlier identification of hidradenitis suppurativa, differentiation from common mimickers, and timely referrals for multidisciplinary management when needed. Engagement of the medical community will also support comprehensive care strategies necessary in hidradenitis suppurativa.
Hidradenitis suppurativa is a progressive inflammatory skin disease that is often underdiagnosed or misdiagnosed because of poor recognition in the medical community.
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Increased awareness of the clinical presentation, associated comorbidities, and quality of life impact can help address unmet needs for patients.
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This practical guide provides detailed information that can support timely hidradenitis suppurativa diagnosis and care strategies by primary care providers.
Statement of Literature Search
This review is based on previously published studies and does not contain novel data. This narrative review included publications identified from a series of PubMed searches from June 2021 through January 2022. A general internet search for relevant resources on hidradenitis suppurativa was also conducted to include useful resources for providers and patients to access. References detailing information on the hidradenitis suppurativa population, clinical presentation, diagnosis, common comorbidities and screenings, impact on patient quality of life and mental health, understanding of hidradenitis suppurativa pathogenesis, therapeutic options, and management were included. Based on the authors’ judgement, publications determined to be irrelevant were excluded from consideration. Any relevant references cited within the publications discussed in this review and articles known by the authors were also considered.
Introduction to Hidradenitis Suppurativa
Hidradenitis suppurativa is a chronic, progressive, and potentially debilitating inflammatory skin disease characterized by painful nodules, abscesses, draining tunnels, and disfiguring scars.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.
Pain, drainage, and odor are among the most burdensome symptoms for patients with hidradenitis suppurativa. In a prospective multinational survey, approximately 60% of patients reported recent hidradenitis suppurativa-related pain as “moderate or higher,” while nearly 5% described recent pain to be “the worst possible.”
Additionally, malodorous drainage frequently requires management. The negative impact of hidradenitis suppurativa on quality of life due to the physical, psychosocial, and comorbid burden of the disease is substantial.
Baseline patient-reported outcomes from UNITE: an observational, international, multicentre registry to evaluate hidradenitis suppurativa in clinical practice.
In part, because of poor recognition of hidradenitis suppurativa within the medical community, the average time from onset of symptoms to diagnosis is approximately 10 years.
During this period, patients may experience disease progression that can lead to disfigurement and disability. Additionally, patients often experience fragmented care for flare management at acute and ambulatory care facilities with a variety of providers.
High burden of hospital resource utilization in patients with hidradenitis suppurativa in England: a retrospective cohort study using hospital episode statistics.
There is an opportunity for primary care and specialty providers to support timely recognition of hidradenitis suppurativa and screening and management for the numerous comorbid conditions associated with the disease.
We provide a comprehensive review of the clinical manifestations, associated comorbidities, and life impact of hidradenitis suppurativa to facilitate early recognition and diagnosis of hidradenitis suppurativa and insights into pathogenesis and therapeutic options.
Recognizing the Clinical Presentation of Hidradenitis Suppurativa
In the absence of a diagnostic biomarker, hidradenitis suppurativa remains a clinical diagnosis defined by 3 major diagnostic criteria: 1) presence of inflammatory nodules, abscesses, and tunnels (fistula or sinus) on the skin; 2) involvement of typical anatomic sites—axillae, inframammary and intermammary folds, inguinal creases, perineal region, and buttocks; and 3) recurrence and chronicity (Figure, A).
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.
Culture of lesions or drainage commonly reveals polymicrobial content or normal skin flora. Hidradenitis suppurativa is an inflammatory disease, and the potential role of the skin microbiome on the surface or in the dermis of the skin is not yet well established.
Some antibiotic strategies have utility in the management of hidradenitis suppurativa; however, it is not yet clear whether their effectiveness relates to their anti-inflammatory or antimicrobial properties.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
Typical hidradenitis suppurativa lesions may be solitary or multiple, and the chronicity of the disease results in significant scarring and disfigurement (Figure, A).
The chronic inflammatory state observed in hidradenitis suppurativa is associated with upregulation of tissue and circulating cytokines, including tumor necrosis factor (TNF) and interleukin (IL)-1, IL-6, and IL-17, among others. Inflammatory cytokine upregulation has been hypothesized as a pathogenic link to several associated comorbid conditions.
A cross-sectional analysis of electronic health record data for patients with hidradenitis suppurativa and matched controls found that patients with hidradenitis suppurativa had significantly higher overall comorbidity burden.
In addition to recognizing the disease early in its course, primary and specialty physicians have a critical role in the interdisciplinary management of patients with hidradenitis suppurativa who require comprehensive comorbidity screening and mitigation strategies.
Comorbid conditions associated with hidradenitis suppurativa include endocrine
A comprehensive comorbidity screening strategy for patients with hidradenitis suppurativa is critical to achieving and maintaining overall health. Primary care providers have an important role in managing and coordinating care for the treatment of these conditions to help manage and improve hidradenitis suppurativa disease burden.
Table 1Common Comorbidities Associated with Hidradenitis Suppurativa
Comorbid Condition
Increased Prevalence or Odds Among Patients with Hidradenitis Suppurativa
Polycystic ovary syndrome
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A large cross-sectional analysis reported a prevalence rate of up to 9.0% for polycystic ovary syndrome in women with hidradenitis suppurativa compared with 2.9% in controls
A retrospective case-control study of US patient data estimated that the increased OR in a multivariate analysis of polycystic ovary syndrome in women with hidradenitis suppurativa is 13.7 times (95% CI, 4.00-47.3) higher than that in control individuals
A case-controlled study found that patients with hidradenitis suppurativa have a greater risk of metabolic syndrome, with an OR of 4.46 compared with control participants
Higher prevalence of dyslipidemia was found in patients with mild and severe hidradenitis suppurativa compared with control individuals (28.8% vs 17.2% and 30.7% vs 18.7%, respectively) in a retrospective cohort analysis of US patient claims data
A retrospective case-control study of US patient data reported an increased OR (95% CI) for experiencing dyslipidemia among patients with hidradenitis suppurativa (4.06 [2.54-6.48]) compared with control individuals
A large meta-analysis demonstrated an increased OR (95% CI) of 1.67 (1.14-2.47) and 2.48 (1.49-4.16) for hypertriglyceridemia and low high-density lipoprotein, respectively, among patients with hidradenitis suppurativa compared with controls
A retrospective study cohort study of patients with hidradenitis suppurativa reported that BMI was significantly higher in patients with hidradenitis suppurativa than in matched controls
This difference was more pronounced in women than in men and in patients diagnosed prior to 40 years of age compared with those diagnosed after 40 years of age
In a cohort study that included population-based registry data for patients with hidradenitis suppurativa, incidence risk of major adverse cardiac events and cardiovascular-related death was 1.5 and 1.6 times higher, respectively, in these patients vs a control population
A retrospective cohort analysis of EHR data for patients with hidradenitis suppurativa reported an increased risk (HR [95% CI]) of myocardial infarction (1.21 [1.12-1.32]; P < .001), cerebrovascular accident (1.22 [1.14-1.31]; P < .001), and major adverse cardiac event (1.23 [1.17-1.30]; P < .001) compared with controls
A retrospective cohort analysis of pregnancy and maternal outcomes for women with hidradenitis suppurativa showed that hidradenitis suppurativa was associated (OR [95% CI]) with spontaneous abortion (1.20 [1.04-1.38]), gestational diabetes (1.26 [1.07-1.48]), and cesarean birth (1.09 [1.004-1.17])
Inflammatory bowel disease, including ulcerative colitis and Crohn disease
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A large cohort study of Danish individuals in national registries found that patients with hidradenitis suppurativa had an increased OR (95% CI) for Crohn disease and ulcerative colitis of 2.04 (1.59-2.62) and 1.75 (1.44-2.13), respectively, compared with the general population
In a cross-sectional analysis of EHR data for patients with hidradenitis suppurativa, the prevalence of Crohn disease was significantly higher in patients with hidradenitis suppurativa than in those without hidradenitis suppurativa (2.0% vs 0.6%; P < .001), and patients with hidradenitis suppurativa had an increased adjusted OR (95% CI) of 3.05 times (2.87-3.25) for Crohn disease
Large retrospective cohort studies have reported an increased risk of developing both depression and generalized anxiety disorder, as well as increased suicidality, in patients with hidradenitis suppurativa compared with control populations
The increased incidence (OR [95% CI]) of sexual dysfunction (1.38 [1.28-1.48]; P < .001) in patients with hidradenitis suppurativa compared with those without hidradenitis suppurativa was reported in an adjusted retrospective analysis of patient EHR data. The 5-year cumulative incidence of sexual dysfunction was found to be 1.7% for patients with hidradenitis suppurativa vs 1.5% for controls
A higher incidence of sexual dysfunction was also found in patients with hidradenitis suppurativa with depressive disorder and generalized anxiety disorder vs those without each disorder
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Depression and anxiety disorders were significant effect modifiers of the relationship between hidradenitis suppurativa and sexual dysfunction
A cross-sectional analysis of EHRs for patients with hidradenitis suppurativa found that 47.9%, 32.7%, and 29.7% of patients experienced substance use disorders related to alcohol, opioids, and cannabis, respectively
A retrospective cohort study of patients with hidradenitis suppurativa reported that patients had 1.53 times greater odds of new long-term opioid use compared with controls
An increased risk of 90% for experiencing a new hidradenitis suppurativa diagnosis among smokers compared with nonsmokers in the United States was estimated in a retrospective cohort study
One retrospective cohort analysis found that the adjusted OR (95% CI) for developing hidradenitis suppurativa was 1.90 (1.84-1.96) among tobacco smokers compared with nonsmokers
A systematic review reported a significant association (OR [95%CI]) between patients with hidradenitis suppurativa and current smoking (4.34 [2.48-7.60]) and obesity (3.45 [2.20-5.38]) compared with control populations
due to affected body areas, malodor, disfigurement, and associated obesity and tobacco smoking. The substantial emotional and psychological impact of hidradenitis suppurativa
Baseline patient-reported outcomes from UNITE: an observational, international, multicentre registry to evaluate hidradenitis suppurativa in clinical practice.
The adjusted odds of depression and suicide among patients with hidradenitis suppurativa compared with those without hidradenitis suppurativa are 1.3 to 4.8 times
Furthermore, the ongoing cost and challenges to access of care and increased health care resource utilization related to managing mental health disorders impose a significant financial burden on patients.
Association between hidradenitis suppurativa and hospitalization for psychiatric disorders: a cross-sectional analysis of the National Inpatient Sample.
Taken together, a thorough understanding of the key clinical features of hidradenitis suppurativa, the psychological impact, and frequent comorbidities will facilitate an identification of hidradenitis suppurativa.
Current Understanding of the Pathogenesis of Hidradenitis Suppurativa
The pathogenic mechanisms of hidradenitis suppurativa are not well understood; however, genetics, microbes, immune dysregulation, and hormonal fluctuations are thought to play important roles in its pathophysiology (Figure, B).
Retrospective cohort studies have reported that up to 40% of patients have a family history of hidradenitis suppurativa, which has also been associated with earlier disease onset.
Mutations in the γ-secretase complex have been identified in patients with hidradenitis suppurativa and are associated with a severe, widespread clinical phenotype.
Preclinical studies have suggested that loss-of-function mutations in γ-secretase genes may lead to initiation of follicular hyperkeratosis and cyst formation similar to hidradenitis suppurativa.
Mutations in genes important in innate immune function have been implicated in hidradenitis suppurativa. Patients with pyogenic arthritis, pyoderma gangrenosum, and acne syndrome can have a hidradenitis suppurativa-like phenotype, and these patients have autosomal dominant mutations in PSTPIP1. Mutations in MEFV, the gene that encodes pyrin and is implicated in familial Mediterranean fever, has also been implicated in hidradenitis suppurativa. These data suggest a potential role for innate immune dysfunction in hidradenitis suppurativa pathogenesis.
Subsequent follicle rupture leads to the seeding of microbes and keratinocyte debris from the hair follicle into the surrounding dermis. A subsequent inflammatory response is triggered and results in the recruitment of inflammatory cells, including neutrophils and lymphocytes, leading to the development of inflammatory lesions.
Elevated levels of circulating complement factors are proposed drivers of neutrophil recruitment and activation that cause subsequent enzyme release in hidradenitis suppurativa lesions.
Elevated levels of tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-alpha and IL-1beta.
The post-adrenarche and premenopausal onset, association with polycystic ovary syndrome, and perimenstrual and peripartum disease flares suggest that hormone dysregulation may be an underlying factor in the pathogenesis of hidradenitis suppurativa.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
While the direct role of sex hormones is not well understood in hidradenitis suppurativa, there is evidence to suggest that patients may experience benefit from anti-androgen therapies.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
Deepening understanding of hidradenitis suppurativa biology will facilitate identification of disease targets that may ultimately lead to development of effective novel therapeutics.
Therapeutic Options and Disease Management
A multifaceted approach to care should include medical and surgical management as well as screening for and managing associated comorbidities. Given the heterogeneity in response to treatments and potential for disease progression, early referral to dermatology should be considered for patients with suspected hidradenitis suppurativa.
Medical treatments for hidradenitis suppurativa are described in Table 2. First-line treatments in early-stage hidradenitis suppurativa include topical and systemic antibiotics.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
Topical management of early hidradenitis suppurativa includes antiseptic cleansers, including benzoyl peroxide wash, and antibiotics, although evidence supporting their efficacy is limited.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
Oral tetracyclines, most commonly doxycycline, as first-line systemic antibiotics for mild disease may improve symptoms via anti-inflammatory activity. Combination oral antibiotic regimens have also shown efficacy.
Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 hidradenitis suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients [online ahead of print].
J Am Acad Dermatol.2020 Jan 10; (S0190-9622(20)30049-9)
Therapeutic strategies for antibiotic regimens should consider the potential benefit with the risk of resistance to optimize treatment duration and frequency. While the role of androgens in hidradenitis suppurativa is unclear, anti-androgen treatments have been observed to improve symptoms.
A paradigm shift in treatment strategy may be needed to focus on early referral to dermatologists (Table 3) and earlier use of biologics that appropriately address the underlying inflammation associated with hidradenitis suppurativa (Table 2). The application of biologics in hidradenitis suppurativa is an evolving area of research. However, the Food and Drug Administration-approved human monoclonal antibody against TNF-α, adalimumab, is approved for use in moderate to severe hidradenitis suppurativa.
Two parallel placebo-controlled phase 3 clinical trials (PIONEER 1 and 2) evaluated adalimumab in adult patients with moderate to severe hidradenitis suppurativa. The primary efficacy outcome of 50% reduction in counts of abscesses and nodules was achieved by significantly more participants who received adalimumab in PIONEER 1 (41.8% vs 26.0%) and PIONEER 2 (58.9% vs 27.6%) than by those who received placebo. Significantly greater improvements in lesion counts, pain, and modified Sartorius score for disease activity were observed in patients who received adalimumab vs placebo.
Furthermore, in an open-label extension follow-up study, sustained improvements in hidradenitis suppurativa clinical response, lesion counts, skin pain, and Dermatology Life Quality Index score were maintained through week 168 with continuous weekly dosing with adalimumab.
Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study.
Efficacy and safety of bimekizumab in moderate to severe hidradenitis suppurativa: a phase 2, double-blind, placebo-controlled randomized clinical trial.
for the treatment of patients with hidradenitis suppurativa. Biologic therapy centered on inhibition of inflammatory cytokines is a therapeutic option for patients with moderate and severe hidradenitis suppurativa. Improved disease management may be achieved with aggressive systemic therapies coupled with appropriate management of comorbidities.
Table 3Resources for Hidradenitis Suppurativa Awareness and Education
Hidradenitis Suppurativa Foundation
Hidradenitis Suppurativa Foundation includes information and resources for both patients and providers about education, management, and events for hidradenitis suppurativa Available online: https://www.hs-foundation.org/ Including a hidradenitis suppurativa clinic finder: https://www.hs-foundation.org/hs-specialty-clinics
AbbVie has compiled an online portal that includes support and resources for both patients and providers to increase hidradenitis suppurativa awareness and education, including patient handouts and conversation guides Available online: https://www.hsdiseasesource.com/resources
Hope for Hidradenitis Suppurativa
Hope for Hidradenitis Suppurativa—a volunteer-based patient and provider nonprofit organization to support and advocate for patients with hidradenitis suppurativa—provides hidradenitis suppurativa resources, such as support group information, patient care information, research, and news Available online: https://hopeforhs.org/
Hidradenitis Suppurativa Connect
Hidradenitis Suppurativa Connect provides resources for providers (dermatologists and general clinicians) and patients (adult and pediatric), including mental health support, community connections and events, and clinical trial recruitment information Available online: https://www.hsconnect.org/
American Academy of Dermatology (AAD)
The AAD has compiled a collection of hidradenitis suppurativa information to increase education and awareness of this disease for providers and patients, including symptoms, causes, treatments, self-care, mechanisms for coping with depression, and dietary changes that may impact hidradenitis suppurativa Available online: https://www.aad.org/public/diseases/a-z/hidradenitis-suppurativa-overview
Surgical interventions have an important role in the management of hidradenitis suppurativa. Deroofing is an ambulatory procedure that can eliminate draining tunnels that open to the surface of the skin.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.
It is important to optimize medical therapy to reduce the inflammatory burden prior to surgical interventions and to emphasize that surgical interventions are not curative or protective against hidradenitis suppurativa.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
A thorough consideration of appropriate therapeutic options and awareness of the potential to shift or combine therapeutic strategies to optimize disease management can facilitate comprehensive patient care.
Comprehensive Patient Care Strategies
Screening and referral when needed for comorbid conditions, including endocrine
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.
The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.
can help patients manage their overall health (Table 4). Mental health disorders are some of the most frequent comorbidities of hidradenitis suppurativa. The Patient Health Questionnaire 2
However, given the associations between hidradenitis suppurativa and smoking and obesity, it is important to counsel patients on the benefits of risk factor modifications to improve overall health outcomes.
Table 4Recommended Screening Methods for Comorbidities Associated with Hidradenitis Suppurativa
Comorbid Condition
Screening Method
Metabolic syndrome and related conditions (eg, glucose dysregulation, hypertension, dyslipidemia, and obesity)
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Assess for abnormality in ≥3 of the following: blood pressure levels, fasted triglyceride levels, fasted HDL levels, fasted blood glucose levels, waist circumference measurement
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Evaluate for dyslipidemia based on fasted lipid panel results
Obesity
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Calculate body mass index with patient height and weight
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Monitor changes
Diabetes mellitus
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Measure glycosylated hemoglobin or fasted blood glucose levels
Polycystic ovary syndrome
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Order basic screening laboratory tests, such as measurement of testosterone, LH, and FSH levels
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Determine whether patient meets Rotterdam criteria for polycystic ovary syndrome of ≥2 of the following: oligo/anovulation, clinical or biochemical hyperandrogenism, and polycystic ovaries on transvaginal ultrasonography examination
Cardiovascular disease and related conditions
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Conduct general cardiovascular disease assessments, including anthropometric and waist circumference measurements, blood pressure levels, fasting lipid and blood glucose levels, tobacco use, physical activity, and diet
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Assess hypertension based on blood pressure measurements
Inflammatory bowel disease
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Screen for abdominal pain experienced ≥3 times weekly for ≥4 weeks
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Screen for bloody stools and diarrhea (>3 bowel movements daily for 7 consecutive days)
Spondyloarthritis
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Screen for joint pain or stiffness that is worse first thing in the morning or after a period of inactivity, but gets better throughout the day
Depression/depressive symptoms
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Initiate assessment by administering the Patient Health Questionnaire-2
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Follow-up with the Patient Health Questionnaire-9 if the Patient Health Questionnaire-2 result is positive
Generalized anxiety disorder
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Administer the Generalized Anxiety Disorder 7-item scale
Suicidality/self-harm
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Utilize item 9 of the Patient Health Questionnaire-9 to assess self-harm
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Screen for history of suicide attempts and any current plans to self-harm
Pain
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Use self-administered patient-reported measures of pain, such as the Brief Pain Inventory short form, numerical rating intensity scale, or pain visual analog scale
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Inquire about pain history, duration, and frequency; pain medication use; and lost workdays
Substance use disorder
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Assess for alcohol abuse with the Alcohol Use Disorders Identification Test-C questionnaire
Acute pain is primarily thought to be neuropathic and typically presents as sharp, burning, stinging, or shooting pain. Acute pain can be experienced with hidradenitis suppurativa inflammatory lesions and frequently requires medical intervention.
Chronic pain is primarily thought to be nociceptive, may be experienced with advanced hidradenitis suppurativa, and is described as gnawing, aching, or tender, and is triggered by mechanical stress.
Topical analgesics, acetaminophen, and nonsteroidal anti-inflammatory medications can be used to treat acute pain in patients with hidradenitis suppurativa. The use of opioids may be necessary for some patients but should be used with caution due to the potential for addiction, misuse, and dependence.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.
Psychological comorbidities that affect perception and tolerance of pain should be considered as part of the optimal pain management strategy for each patient. Ultimately, referral to a pain management or palliative care specialist may be necessary.
Resources are available to support awareness in and education of patients with hidradenitis suppurativa related to disease course, disease impact, and opportunities to engage behaviors that may support overall health (Table 3). Patients will also benefit from understanding the inflammatory nature of the disease and the potential for immunomodulating therapies to control disease symptoms.
Conclusion
Several opportunities to improve care and outcomes for patients with hidradenitis suppurativa are available. Timely disease recognition and management are essential to controlling symptoms, mitigating disease progression, and improving quality of life for patients with hidradenitis suppurativa. Comprehensive care strategies coordinated among medical and surgical disciplines are necessary to improve the overall health of patients with hidradenitis suppurativa.
Acknowledgments
Medical writing support was provided by Charli Dominguez, PhD, CMPP, of Health Interactions, Inc, Chicago, IL, and was funded by Novartis Pharmaceuticals Corporation. This manuscript was developed in accordance with Good Publication Practice (GPP3) guidelines. Authors had full control of the content and made the final decision on all aspects of this publication.
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North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management.
Baseline patient-reported outcomes from UNITE: an observational, international, multicentre registry to evaluate hidradenitis suppurativa in clinical practice.
High burden of hospital resource utilization in patients with hidradenitis suppurativa in England: a retrospective cohort study using hospital episode statistics.
North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management.
Association between hidradenitis suppurativa and hospitalization for psychiatric disorders: a cross-sectional analysis of the National Inpatient Sample.
Elevated levels of tumour necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-10 in hidradenitis suppurativa skin: a rationale for targeting TNF-alpha and IL-1beta.
Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 hidradenitis suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients [online ahead of print].
J Am Acad Dermatol.2020 Jan 10; (S0190-9622(20)30049-9)
Long-term adalimumab efficacy in patients with moderate-to-severe hidradenitis suppurativa/acne inversa: 3-year results of a phase 3 open-label extension study.
Efficacy and safety of bimekizumab in moderate to severe hidradenitis suppurativa: a phase 2, double-blind, placebo-controlled randomized clinical trial.
The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.
Funding: Support for third-party writing assistance for this manuscript was provided by Novartis.
Conflicts of Interest: AG has served as an advisor and/or received honoraria from AbbVie, Aclaris Therapeutics, AnaptysBio, Aristea Therapeutics, Boehringer Ingelheim, Bristol Meyers Squibb, Incyte, InflaRx, Insmed, Janssen, Novartis, Pfizer, UCB, and Viela Biosciences; has received research grants from AbbVie, UCB, and National Psoriasis Foundation; and is co-copyright holder of the Hidradenitis Suppurativa Investigator Global Assessment and Hidradenitis Suppurativa Quality of Life instruments. HBN has received consulting fees from 23andMe, AbbVie, Aristea Therapeutics, DAVA Oncology, and Nimbus Therapeutics; advisory fees from Boehringer Ingelheim; investigator fees from Pfizer; grant support from AbbVie; serves as an associate editor for JAMA Dermatology; and is a board member of the US Hidradenitis Suppurativa Foundation. JSK has received speaker and consultant fees from AbbVie; consultant fees from ChemoCentryx, Incyte, Janssen, Novartis, and UCB; and grant support from Incyte.
Authorship: All authors made substantial contributions to the conception and methodology of this literature review; were involved in drafting and critically revising the manuscript; have given necessary attention to ensure the integrity of the work; and have read and approved all versions of this manuscript and its submission.
Adalimumab is the only Food and Drug Administration-approved treatment for hidradenitis suppurativa.
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