North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part I: Diagnosis, evaluation, and the use of complementary and procedural management

J Am Acad Dermatol. 2019 Jul;81(1):76-90. doi: 10.1016/j.jaad.2019.02.067. Epub 2019 Mar 11.


Hidradenitis suppurativa is a chronic inflammatory disorder affecting hair follicles, with profoundly negative impact on patient quality of life. Evidence informing ideal evaluation and management of patients with hidradenitis suppurativa is still sparse in many areas, but it has grown substantially in the last decade. Part I of this evidence-based guideline is presented to support health care practitioners as they select optimal management strategies, including diagnostic testing, comorbidity screening, and both complementary and procedural treatment options. Recommendations and evidence grading based on the evidence available at the time of the review are 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

  • Anti-Bacterial Agents
  • Biological Products / therapeutic use*
  • Canada
  • Complementary Therapies
  • Dermatologic Surgical Procedures / methods
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Female
  • Hidradenitis Suppurativa / diagnosis*
  • Hidradenitis Suppurativa / therapy*
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Male
  • North America
  • Practice Guidelines as Topic*
  • Publishing
  • Risk Assessment
  • Severity of Illness Index
  • United States


  • Anti-Bacterial Agents
  • Biological Products
  • Immunosuppressive Agents