Hidradenitis Suppurativa Treatment Guidelines

Disease Assessment and Staging

The American Academy of Dermatology recommends evaluating disease severity using the Hurley staging system to guide appropriate treatment selection 2, 3
The British Association of Dermatologists suggests monitoring treatment response using the Hidradenitis Suppurativa Clinical Response (HiSCR), which measures reduction in inflammatory lesions 2, 4
The American Academy of Dermatology recommends assessing patient-reported outcomes including pain (Visual Analog Scale) and quality of life (Dermatology Life Quality Index) 5, 3

The American Academy of Dermatology recommends topical clindamycin 1% solution/gel twice daily for 12 weeks as first-line therapy for mild disease (Hurley Stage I) 1, 2
The British Association of Dermatologists suggests oral tetracyclines such as doxycycline or lymecycline for at least 12 weeks as first-line therapy for moderate disease (Hurley Stage II) 5, 2
The American Academy of Dermatology recommends adalimumab 160 mg at week 0, 80 mg at week 2, then 40 mg weekly starting at week 4 as first-line biologic therapy for severe disease (Hurley Stage III or refractory moderate disease) 6, 5, 4

The American Academy of Dermatology recommends considering extensive excision in patients with severe disease with sinus tracts and scarring 6, 5
The British Association of Dermatologists suggests considering extensive excision when conventional systemic treatments have failed 5, 2

The American Academy of Dermatology recommends metformin for pregnant patients requiring anti-androgens 7, 2
The American Academy of Dermatology recommends adalimumab for pregnant patients requiring biologics 7, 2

The American Academy of Dermatology recommends encouraging weight loss for patients with obesity 2, 3
The British Association of Dermatologists suggests recommending smoking cessation 5, 2
The American Academy of Dermatology recommends screening for depression, anxiety, and cardiovascular risk factors 5, 2

The British Association of Dermatologists recommends not offering isotretinoin unless there are concomitant moderate-to-severe acneiform lesions of the face or trunk 5
The American Academy of Dermatology recommends not offering adalimumab 40 mg every other week (insufficient dosing) 5, 4
The British Association of Dermatologists suggests not offering etanercept 5
The British Association of Dermatologists recommends not offering cryotherapy to treat lesions during the acute phase due to pain from the procedure 5
The British Association of Dermatologists suggests not offering microwave ablation 5