Hidradenitis Suppurativa

Confirm the characteristic distribution of recurrent deep nodules, abscesses, draining tunnels, and scarring in axillary, inguinal, genitoanal, or inframammary skin. A solitary acute lesion without a recurrent intertriginous pattern should prompt reassessment for an alternative local process rather than automatic labeling as HS. ScienceDirect+1ScienceDirectHidradenitis suppurativa - ScienceDirect.comScienceDirectA concise clinician’s guide to therapy for hidradenitis suppurativa

At each baseline and escalation visit, record anatomic regions involved; counts of abscesses and inflammatory nodules; draining tunnels; pain; drainage; and the dominant morphology at each site. This distinguishes an inflammatory phase, in which drug therapy is emphasized, from destructive disease with tunnels and fibrosis, in which combined medical-surgical treatment is generally required, and a burnout phase in which surgery may be the principal intervention. ScienceDirectScienceDirectHidradenitis suppurativa - ScienceDirect.com

Assign Hurley stage to the most involved area to communicate structural burden and surgical candidacy. Use it alongside a dynamic lesion measure such as IHS4 or total inflammatory lesion count when judging treatment response, because Hurley staging was developed for surgical stratification and is most dependable for the most involved stage III disease. The Lancet+2The LancetHidradenitis suppurativa - The LancetOxford AcademicA centre-based ambulatory care concept for hidradenitis suppurativa ...Oxford Academicand intrarater reliability of Hurley staging for hidradenitis suppurativa

Assess for metabolic syndrome at diagnosis and during longitudinal care, particularly in patients with obesity or other cardiometabolic risk factors. HS is associated with metabolic syndrome; identify hypertension, dysglycemia, dyslipidemia, and central adiposity using the clinician's usual primary-care or cardiometabolic framework, then treat each abnormality directly rather than considering weight alone as the only modifiable issue. JAMAJAMAAssociation of Metabolic Syndrome and Hidradenitis Suppurativa

Elicit chronic diarrhea, abdominal pain, hematochezia, weight loss, and perianal symptoms. HS is associated with inflammatory bowel disease, so compatible gastrointestinal symptoms should prompt evaluation for Crohn disease or ulcerative colitis and coordination with gastroenterology before selecting or changing systemic immune-directed therapy. JAMAJAMAAssociation of Hidradenitis Suppurativa With Inflammatory Bowel ...

Before adalimumab, apply the product-label infection assessment, including evaluation for active tuberculosis and latent tuberculosis infection. The adalimumab label carries a boxed warning for serious infections, including active TB and reactivation of latent TB; defer initiation when clinically significant infection requires treatment. accessdata fdaaccessdata fda[PDF] BLA761151Orig1s010 - accessdata.fda.gov

For limited disease, topical antimicrobials such as clindamycin are used in practice; for more extensive or recalcitrant inflammatory disease, systemic antibiotics, antiandrogen therapy, retinoids, metformin, corticosteroids, and several immunomodulators have been used off label. Antibiotics are commonly employed but their evidence base is limited and HS is a chronic inflammatory condition rather than a primary infection. accessdata fda+2accessdata fda[PDF] BLA761151Orig1s010 - accessdata.fda.govWileyEpidemiology and Diagnostic Tools (Clinical Phenotypes, Outcome ...ema europa eu[PDF] Secukinumab - European Medicines Agency

For moderate-to-severe disease requiring FDA-approved systemic treatment, select among TNF and IL-17 pathway inhibitors in conjunction with dermatology-led longitudinal assessment. Adalimumab, secukinumab, and bimekizumab are identified as U.S.-approved therapies for moderate-to-severe HS; adalimumab has pivotal phase 3 trial evidence, and secukinumab demonstrated rapid improvement in moderate-to-severe disease in phase 3 study reporting. NEJM+3NEJMTwo Phase 3 Trials of Adalimumab for Hidradenitis SuppurativaThe LancetSecukinumab in moderate-to-severe hidradenitis suppurativa ...ScienceDirectHidradenitis suppurativa - ScienceDirect.comaadHidradenitis suppurativa: Diagnosis and treatment

Use the labeled adult HS adalimumab regimen: 160 mg subcutaneously initially, 80 mg subcutaneously at week 2, then 40 mg weekly or 80 mg every other week beginning 2 weeks later. This regimen is approved for adults with chronic moderate-to-severe HS; the indication also includes adolescents aged 12 years or older who weigh more than 30 kg. accessdata fdaaccessdata fda[PDF] BLA761151Orig1s010 - accessdata.fda.gov

Assess response with lesion counts and drainage rather than scar appearance alone. The common trial endpoint HiSCR requires at least a 50% reduction in total abscess and inflammatory nodule count; ongoing tunnel drainage, expanding fibrosis, or recurrent disease in the same scarred unit despite reduced inflammatory counts should prompt procedural reassessment rather than simply extending a failing medical-only strategy. The Lancet+1The LancetEfficacy and safety of bimekizumab in patients with moderate-to ...ScienceDirectHidradenitis suppurativa - ScienceDirect.com

Refer early for surgical evaluation when there are chronic draining tunnels, irreversible fibrosis, morbid scarring, or recurrent lesions within a fixed anatomic unit. Chronic inflammation produces tunnel formation and irreversible skin damage; once fibrosis is established, medical treatment can control only part of the symptom burden and definitive lesion management is surgical. ScienceDirect+1ScienceDirectHidradenitis suppurativa - ScienceDirect.comema europa eu[PDF] Secukinumab - European Medicines Agency

Use incision and drainage only when immediate evacuation of an acute abscess is clinically necessary, with explicit counseling that recurrence is common in HS. Repeated incision and drainage without a plan for the underlying tunnel network perpetuates episodic care and should trigger referral for excision-based or other definitive procedural planning. ScienceDirect+1ScienceDirectA concise clinician’s guide to therapy for hidradenitis suppurativaaccessdata fda[PDF] BLA761151Orig1s010 - accessdata.fda.gov

Coordinate timing around inflammatory control rather than treating medical and surgical care as mutually exclusive. Adalimumab has been combined with wide excision and secondary-intention healing without an observed excess of postoperative complications or hemorrhage in cited evidence, but continued surveillance for infection and wound complications remains necessary. WileyWileyEuropean S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment - Zouboulis - 2025 - Journal of the European Academy of Dermatology and Venereology - Wiley Online Library

At each therapeutic reassessment, compare inflammatory nodule and abscess counts, drainage, pain, flare frequency, and sites of new involvement with the baseline record. A reduction of at least 50% in total abscess and inflammatory nodule count is the HiSCR threshold used in pivotal HS trials; persistent disease below this response level supports changing or intensifying the treatment plan. The Lancet+2The LancetEfficacy and safety of bimekizumab in patients with moderate-to ...NEJMTwo Phase 3 Trials of Adalimumab for Hidradenitis SuppurativaThe LancetSecukinumab in moderate-to-severe hidradenitis suppurativa ...

Monitor structural progression separately: new tunnels, expansion of scarred territory, recurrent drainage from an established tunnel, and increasing procedural complexity are escalation signals even when inflammatory lesion counts improve. Medical therapy targets the inflammatory phase, whereas destructive and burnout phases require increasing emphasis on surgery. ScienceDirectScienceDirectHidradenitis suppurativa - ScienceDirect.com

For patients receiving adalimumab, maintain vigilance for serious infection and tuberculosis during treatment because the product labeling warns about serious infections, including active TB and latent TB reactivation. Reevaluate systemic therapy promptly when infection is suspected rather than attributing fever, worsening drainage, or systemic symptoms to an ordinary HS flare. accessdata fdaaccessdata fda[PDF] BLA761151Orig1s010 - accessdata.fda.gov