Guidelines for the management of hidradenitis suppurativa: recommendations supported by the Centre of Evidence of the French Society of Dermatology

Abstract

Dear Editor, Hidradenitis suppurativa (HS) is a painful chronic inflammatory skin disease that impacts quality of life substantially. Its prevalence is estimated to be 0·7%.1 Various pathophysiological hypotheses exist, but there is no therapeutic consensus, which complicates the management of patients with HS. Therefore, the Centre of Evidence of the French Society of Dermatology initiated a standardized recommendation process for HS. A 13-member working group (WG) was formed, comprising dermatologists (A.B., E.S., M.M.-B., I.B.-V., N.J., J.-F.S.), a plastic surgeon (P.P.), an emergency physician (Y.Y.), an infectious diseases specialist (E.C.), a microbiologist (O.J.-L.), a psychologist (K.C.), a general practitioner (S.S.) and a patient representative from an HS patient association. Members had no conflicts of interest and a strict methodology was followed.2 Firstly, a systematic review of the literature was performed to compile references from study inception to September 2018. Assistance was provided by the French National Health Authority medical health librarian (supporting information available on request from the author). Eight physicians specializing in methodology then extracted data from each report (supporting information available on request from the author) and analysed the methodology and risk of bias using the Appraisal of Guidelines for Research & Evaluation instrument for guidelines, the Assessing Methodological quality for Systematic Reviews tool for systematic reviews and the risk-of-bias tool for randomized controlled trials (Cochrane Collaboration).3 Observational studies were retained if they included more than 20 patients. Senior experts were interviewed and their comments were incorporated into the manuscript. Finally, the draft recommendations were submitted to a multidisciplinary panel of 36 reviewers. French guidelines for hidradenitis suppurativa (HS) management: treatment algorithm for HS in adults. d, day; IV, intravenous; IM, intramuscular; SC, subcutaneous; PO, per os. A medicosurgical approach is strongly recommended for all patients, either after or in combination with medical steps. Surgery (assisted by ultrasounds, probes, etc.) is considered a curative treatment for specific lesions, but surgeons must fully understand the need to maintain adequate margins, as in skin carcinoma surgery, to achieve remission. After final proofreading by the Centre of Evidence (O.C., M.B.-B)., the algorithm was published on a dedicated open-access website to provide a user-friendly and practical tool featuring fast, step-by-step navigation according to clinical situations (https://reco.sfdermato.org/en/). HS is a chronic disease requiring long-term and multidisciplinary management that takes into consideration the pain and psychological impact, the different medical and surgical treatments available and the preservation of the microbial ecology. a full list of acknowledgments is available in File S1 (see Supporting Information). Antoine Bertolotti: Data curation (lead); Formal analysis (equal); Funding acquisition (equal); Investigation (equal); Methodology (equal); Resources (equal); Writing-original draft (lead). Emilie Sbidian: Conceptualization (equal); Formal analysis (equal); Funding acquisition (equal); Methodology (lead); Project administration (equal); Resources (equal); Supervision (equal); Validation (equal); Visualization (equal); Writing-review & editing (equal). Olivier Join-Lambert: Formal analysis (equal); Funding acquisition (equal); Investigation (equal); Resources (equal); Validation (equal); Writing-review & editing (equal). Isabelle Bourgault: Funding acquisition (equal); Investigation (equal); Visualization (equal); Writing-review & editing (equal). Micheline Moyal-Barracco: Data curation (equal); Formal analysis (equal); Investigation (equal); Resources (equal); Validation (equal); Visualization (equal); Writing-review & editing (equal). Pierre Perrot: Investigation (equal); Validation (equal); Visualization (equal); Writing-review & editing (equal). Nicole Jouan: Funding acquisition (equal); Investigation (equal); Visualization (equal); Writing-review & editing (equal). Youri Yordanov: Investigation (equal); Visualization (equal); Writing-review & editing (equal). Stéphanie Sidorkiewicz: Investigation (equal); Visualization (equal); Writing-review & editing (equal). Karine Chazelas: Investigation (equal); Visualization (equal); Writing-review & editing (equal). Marie-France Bru-Daprés: Funding acquisition (equal); Investigation (equal); Visualization (equal); Writing-review & editing (equal). Eric Caumes: Funding acquisition (equal); Investigation (equal); Validation (equal); Visualization (equal); Writing-review & editing (equal). Jean-François Sei: Conceptualization (lead); Funding acquisition (equal); Investigation (equal); Project administration (lead); Supervision (lead); Validation (equal); Visualization (equal); Writing-review & editing (equal). Olivier Chosidow: Project administration (supporting); Software (supporting); Visualization (equal); Writing-review & editing (equal). Marie Beylot-Barry: Software (lead); Visualization (equal); Writing-review & editing (equal). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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