European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment

医学 化脓性汗腺炎 阿达木单抗 皮肤病科 克林霉素 痤疮 外科 抗生素 疾病 内科学 微生物学 生物
作者
Christos C. Zouboulis,Falk G. Bechara,Farida Benhadou,Vincenzo Bettoli,Zrinka Bukvić Mokoš,V. del Mármol,Mateja Dolenc‐Voljč,Evangelos J. Giamarellos‐Bourboulis,Øystein Grimstad,Philippe Guillem,Barbara Horváth,Robert E. Hunger,J.R. Ingram,D. Ioannides,Elke Just,Lajos Kemény,Brian Kirby,Aikaterini I. Liakou,Barry M. McGrath,Angelo Valerio Marzano,Łukasz Matusiak,Alejandro Molina‐Leyva,Aude Nassif,Maurizio Podda,Errol P. Prens,Francesca Prignano,Hélène Raynal,Marco Romanelli,Ditte Marie Lindhardt Saunte,Andrea Szegedi,Jacek C. Szepietowski,Thrasyvoulos Tzellos,Skaidra Valiukevičienė,Hessel H. van der Zee,Kelsey R. van Straalen,Bente Villumsen,Gregor B. E. Jemec
出处
标识
DOI:10.1111/jdv.20472
摘要

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.

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