Afsaneh Alavi1, Charles Lynde1, Raed Alhusayen1, Marc Bourcier2, Isabelle Delorme3, Ralph George4, Melinda Gooderham5, Wayne Gulliver6, Sunil Kalia7, Danielle Marcoux8, Yves Poulin9. 1. 1 Department of Medicine (Dermatology), University of Toronto, Toronto, ON, Canada. 2. 2 Sherbrooke University, Sherbrooke, QC, Canada. 3. 3 Clinique Dre Isabelle Delorme, Drummondville, QC, Canada. 4. 4 Division of General Surgery, St Michael's Hospital, Toronto, ON, Canada. 5. 5 Department of Medicine, Queen's University, Kingston, ON, Canada. 6. 6 Department of Medicine, Memorial University of Newfoundland, St John's, ND, Canada. 7. 7 Department of Medicine, Division of Dermatology and Skin Sciences, UBC, Vancouver, BC, Canada. 8. 8 Department of Pediatrics, Division of Dermatology, University of Montreal and CHU Ste Justine, Montreal, QC, Canada. 9. 9 Centre de Recherche Dermatologique du Québec Metropolitain, Quebec, QC, Canada.
Abstract
BACKGROUND: Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse. OBJECTIVES: To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS. METHODS: An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%. RESULTS: Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education. CONCLUSIONS: These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti-tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.
BACKGROUND:Hidradenitis suppurativa (HS) is a painful, debilitating, and poorly understood condition, which is suboptimally diagnosed, managed, and treated. Evidence supporting various treatment modalities is sparse. OBJECTIVES: To incorporate scientific evidence and expert opinions to develop useful guidance for the evaluation and management of patients with HS. METHODS: An expert panel of Canadian dermatologists and surgeons developed statements and recommendations based on available evidence and clinical experience. The statements and recommendations were subjected to analysis and refinement by the panel, and voting was conducted using a modified Delphi technique with a prespecified cutoff agreement of 75%. RESULTS: Ten specific statements and recommendations were accepted by the expert panel. These were grouped into 4 domains: diagnosis and assessment, treatment and management, comorbidities and a multidisciplinary approach, and education. CONCLUSIONS: These statements and recommendations will serve to increase awareness of HS and provide a framework for decisions involving diagnosis and management. Evidence suggests that antibacterial and anti-tumour necrosis factor therapies are effective in the treatment of HS. This is supported by the clinical experience of the authors. Further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS in Canada.
Authors: Kevin T Savage; Vinita Singh; Zarine S Patel; Christine A Yannuzzi; Anne Marie McKenzie-Brown; Michelle A Lowes; Lauren A V Orenstein Journal: J Am Acad Dermatol Date: 2020-09-17 Impact factor: 15.487