British Association of Dermatologists Guidelines for the Management of Hidradenitis Suppurativa (Acne Inversa) 2018

J.R. Ingram; F. Collier; D. Brown; T. Burton; J. Burton; M.F. Chin; N. Desai; T.E.E. Goodacre; V. Piguet; A.E. Pink; L.S. Exton; M.F. Mohd Mustapa


The British Journal of Dermatology. 2019;180(5):1009-1017. 

In This Article


This set of guidelines has been developed using the BAD's recommended methodology[1] (see further information in Appendix J; see Supporting Information for details of all Appendices) with reference to the Appraisal of Guidelines Research and Evaluation (AGREE II) instrument ([2] and the Grading of Recommendations Assessment, Development and Evaluation (GRADE).[3] Recommendations were developed for implementation in the U.K. National Health Service (NHS).

The GDG, which consisted of consultant dermatologists, a consultant plastic surgeon, a general practitioner, a dermatology registrar, a clinical nurse specialist, patient representatives and a technical team (consisting of a guideline research fellow and project manager providing methodological and technical support), established several clinical questions pertinent to the scope of the guideline and a set of outcome measures of importance to patients, ranked according to the GRADE methodology (see section 3·1).

A systematic literature search of PubMed, MEDLINE, EMBASE, Cochrane and AMED databases was conducted by the technical team to identify key articles for HS up to July 2018; search terms and strategies are detailed in the Supporting information (Appendix K). Additional references relevant to the topic were also isolated from citations in reviewed literature. Data extraction and critical appraisal were carried out by two clinicians and checked by the technical team. Data synthesis, evidence summaries, lists of excluded studies and the PRISMA diagram were prepared by the technical team. Evidence from included studies was rated according to the GRADE system (high, moderate, low or very low quality). Recommendations are based on evidence drawn from systematic reviews of the literature pertaining to the clinical questions identified, following discussions with the entire GDG and considering all four factors that would affect its strength rating according to the GRADE approach (i.e. balance between desirable and undesirable effects, quality of evidence, patient values and preferences and resource allocation). All GDG members contributed towards drafting and/or reviewing the narratives and information in the guideline and supporting information documents. When there is insufficient evidence from the literature, informal consensus is reached based on the experience of the GDG. The summary of findings with forest plots (Appendix D), GRADE evidence profiles indicating the quality of evidence (Appendix E), clinical evidence summary (Appendix B), summary of included comparative studies (Appendix F), narrative findings tables for noncomparative studies (Appendix G), tables linking the evidence to the recommendations (Appendix C), PRISMA flow diagram (Appendix H) and lists of excluded studies (Appendix I) are detailed in the Supporting Information. The strength of recommendation is expressed by the wording and symbols as shown in Table 1.