North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management

J Am Acad Dermatol. 2019 Jul;81(1):91-101. doi: 10.1016/j.jaad.2019.02.068. Epub 2019 Mar 11.


Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.

Keywords: Nd:YAG; acne inversa; adalimumab; biomarkers; carbon dioxide laser; clindamycin; comorbidities; ertapenem; finasteride; guidelines; hidradenitis suppurativa; infliximab; laser; lifestyle modification; microbiome; oral contraceptive pills; rifampin; spironolactone.

Publication types

  • Review

MeSH terms

  • Administration, Oral
  • Administration, Topical
  • Androgen Antagonists / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Canada
  • Evidence-Based Medicine
  • Female
  • Hidradenitis Suppurativa / diagnosis*
  • Hidradenitis Suppurativa / drug therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Injections, Intralesional
  • Male
  • North America
  • Practice Guidelines as Topic*
  • Prognosis
  • Publications
  • Risk Assessment
  • Treatment Outcome
  • United States


  • Androgen Antagonists
  • Anti-Bacterial Agents
  • Immunosuppressive Agents