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


There is currently a paucity of effective treatment options for HS, but common medical therapy approaches include antiseptic washes, steroid injections, topical and oral antibiotics (single agents or combination treatment), retinoids, dapsone, oral contraceptive agents, oral immunomodulators, and antitumour necrosis factor (anti-TNF) therapy. Surgical procedures range from incision and drainage for acute flares, narrow margin excision and extensive excision with closure by secondary intention, skin flap or graft. Other treatment options include radiotherapy, psoralen plus ultraviolet A phototherapy, photodynamic therapy and laser therapy.

Clinical Questions and Outcomes

Management strategies in HS are highly variable and are currently undertaken by both generalists and specialists spanning emergency medicine, internal medicine, dermatology, plastic surgery, urology, gynaecology and general surgery. To address these matters the GDG established several clinical questions pertinent to the scope of the guideline.

In people with HS:

1. What is the efficacy and safety of medical interventions?

  • topical

  • conventional systemic

  • biological

  • laser and light

  • other therapies

2. What is the efficacy and safety of surgical interventions?

3. What are the self-management options and the evidence to support them?

The GDG also established two sets of outcome measures of importance to patients (see Table 2), one for medical interventions and another for surgery; these were ranked according to the GRADE methodology[4] by patient/carer representatives, data on which are extracted from included studies (see Appendix F). Outcomes ranked 7, 8 and 9 are critical for decision-making; those ranked 4, 5 and 6 are important but not critical for decision-making: