Hidradenitis suppurativa is a chronic, disabling condition that often relentlessly progresses. Occurring in often otherwise healthy adolescents and adults, this rare disease manifests in painful lesions that may cause hypertrophic scars and immobility. Historically, it is often underdiagnosed because patients are embarrassed to seek help for the condition, which significantly impacts on daily life, physically, emotionally and psychologically. Diagnosis of the disease is primarily clinical with no pathogonomic tests currently available. Many uncertainties remain following diagnosis, including the course of the disease, the number of flare-ups that may occur and expectation of a life free of symptoms. Medical management is recommended in the early stages. Other interventions, including laser treatment, offer an alternative to surgery in mild-to-severe cases with surgery deemed as the most efficacious option in chronic and recurrent stages of HS. Surgical treatment remains the most common and accepted modality for HS, because many traditional, non-surgical interventions do not result in a lasting cure. Several surgical treatment methods co-exist and are recommended with the type of surgery and margins selected based on severity of the disease and body region affected.
This Position Document looks at the management and care of HS across the treatment spectrum.
Paper 1 looks at the efficacy of currently available treatment options and details the medical therapies available for treatment of HS, including topical therapies and systemic treatments such as antibiotics, sulphones, retinoids, hormones and immunosuppressants to laser treatment and radical surgery.
Paper 2 takes a deep dive into the pre- and post-surgical landscape of HS with an in-depth look at conventional surgery, CO2 laser therapy and experimental therapies, and their varying success rates.
Paper 3 explores the impact the condition has on patients’ quality of life with an in-depth look at the use of quality of life indexes as part of a care management plan. It also seeks to address some of the treatment and dressing inequalities that exist in managing and treating the condition, and how the social and economic impact of HS could and should be addressed.
World Union of Wound Healing Societies (WUWHS)
Understanding hidradenitis suppurativa
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Authors: Valentina Dini, MD PhD, Assistant Professor, Department of Dermatology, University of Pisa, Italy Afsaneh Alavi, Assistant Professor of Medicine (Dermatology), University of Toronto, Ontario, Canada Thomas Wild, Surgeon, Wound Center Dessau-Rosslau Department of Dermatology, Dessau Municipal Hospital, Germany Reviewers Robert Kirsner, Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA Peter Vowden, Visiting Honorary Professor of Wound Healing Research, University of Bradford and Honorary Consultant Vascular Surgeon, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UKManaging HS Pathology Treatment Underdiagnosed