Medical and Surgical Management of Hidradenitis Suppurativa: A Review of International Treatment Guidelines and Implementation in General Dermatology Practice

Dermatology. 2020;236(5):393-412. doi: 10.1159/000507323. Epub 2020 May 14.


Background: Hidradenitis suppurativa (HS) is a chronic painful skin disease that severely impairs patients' quality of life. While high-quality trials of HS therapies remain limited, medical knowledge of best treatment practices is rapidly evolving, leading to the recent publication of multiple international treatment guidelines for HS.

Summary: This review compares international HS treatment guidelines, describes evidence for effectiveness of common and emerging HS therapies, and provides guidance for integrating evidence-based HS care into practice. Although over 50 medical and procedural treatments are mentioned across international HS guidelines, only adalimumab and infliximab have grade B/weak recommendation or higher across all major guidelines. This review describes the appropriate patient selection and effectiveness of the most commonly used medical and procedural treatments for HS. It also includes recommendations for counseling, dosing, and duration of medical therapies as well as procedure videos for the practicing dermatologist.

Keywords: Acne inversa; Biologicals; Hidradenitis suppurativa; Surgical techniques.

Publication types

  • Review

MeSH terms

  • Adalimumab / therapeutic use
  • Anti-Bacterial Agents / therapeutic use
  • Dermatologic Agents / therapeutic use*
  • Dermatologic Surgical Procedures*
  • Dermatology / standards
  • Hidradenitis Suppurativa / drug therapy*
  • Hidradenitis Suppurativa / surgery*
  • Humans
  • Infliximab / therapeutic use
  • Internationality
  • Practice Guidelines as Topic*


  • Anti-Bacterial Agents
  • Dermatologic Agents
  • Infliximab
  • Adalimumab