British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018 J.R. Ingram,1 F. Collier,2,3 D. Brown,4 T. Burton,5 J. Burton,5 M.F. Chin,6 N. Desai,4 T.E.E. Goodacre,7 V. Piguet,1,8 A.E. Pink,4 L.S. Exton,9 M.F. Mohd Mustapa9 1Division of Infection & Immunity, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, U.K. 2Alva Medical Practice, West Johnstone Street, Alva, FK12 5BD, U.K. 3Dermatology Department, Stirling Community Hospital, FK8 2AU, U.K. 4St. John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London SE1 7EH, U.K. 5The Hidradenitis Suppurativa Trust, Chatham ME4 9AH, U.K. 6Great Western Hospitals NHS Foundation Trust, Marlborough Road, Swindon, Wiltshire, SN3 6BB, U.K. 7Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Headington, Oxford OX3 9DU, U.K. 8Division of Dermatology, Women’s College Hospital, Toronto; Division of Dermatology, Department of Medicine, University of Toronto, Canada 9British Association of Dermatologists, Willan House, 4 Fitzroy Square, London W1T 5HQ, U.K. British Journal of Dermatology. DOI: 10.111/bjd.17537

Dr John Ingram

Introduction What’s already known? Hidradenitis suppurativa (HS) is relatively common Higher risks of cardiovascular (CV) disease and depression Management includes medical & surgical interventions Until now, there were no UK guidelines for HS care

Methods British Association of Dermatologists commissioned a HS guideline development group Membership: Information scientists, a HS patient and carer, UK clinicians including dermatologists, a dermatology nurse, plastic surgeon and GP Systematic review performed Evidence converted to recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system

Results

Initial management (primary and secondary care) Patient information leaflet Record baseline disease severity Measure pain and treat if needed Provide wound dressings if required Screen for CV disease risk factors & depression/anxiety Offer smoking cessation and/or weight management referral if relevant Oral tetracycline therapy (lymecycline/ doxycycline)

After tetracyclines

Audit criteria Patient information leaflet Smoking & weight management referrals, where relevant Screening for co-morbidities (depression, CV risk) Documented baseline disease stage & ongoing severity Pre-operative discussion for those undergoing surgery Adherence to NICE Adalimumab criteria

Guideline Development Group Debbie Brown Specialist nurse Tara Burton, James Burton - Patient representatives Fiona Collier GP Vincent Piguet, Andrew Pink, John Ingram - Dermatologists Tim Goodacre Plastic surgeon Firouz Mustapa Information Scientist Lesley Exton Information Scientist Mei Chin Dermatology trainee (at start!)

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