Hidradenitis Suppurativa- Diagnosis, Evaluation and that Use of Complementary and Procedural Management

Publication Date: July 1, 2019
Last Updated: March 14, 2022


Grading and Classification

Clinical performance, Hurley staging, and inflammatory lesion counts (abscesses and inflammatory lesions) are recommended.
Consider clinically following pain VAS and DLQI.
The recommended grading systems in research studies are the HiSCR, HS-PGA, Sartorius score, DLQI, and pain VAS; the HSIA and HSSA can also be considered.

Screening for Comorbidities

Perform a review of systems and a physical examination to screen for metabolic syndrome, depression, anxiety, diabetes, PCOS, and tobacco abuse.
Refer patients with additional risk factors for diabetes such as obesity, hypertension, hyperlipidemia, and acanthosis nigricans for HbA1c and/or fasting glucose testing.
Screen for depression, inflammatory bowel disease, autoinflammatory syndromes, and inflammatory arthropathy based on review of systems.

Lifestyle Modifications and Alternative Treatments

Counsel smoking cessation.
Screen for obesity and counsel weight loss.
May recommend oral zinc supplements (weak evidence).
Insufficient evidence exists to recommend avoidance of dairy or brewer’s yeast, vitamin D supplementation, avoidance of friction, deodorant, and depilation/shaving.

Surgical Modalities

Recurrent nodules and tunnels may be best treated with deroofing or excision. Incision and drainage is recommended only for acute abscesses to relieve pain.
Wide local scalpel, CO2, or electrosurgical excision (with or without reconstruction) is appropriate for extensive chronic lesions.
Wound healing following surgery may be through secondary intention, primary closure, delayed primary closure, flaps, grafts, and/or skin substitutes.
Experience suggests that continuing medical therapy in the perioperative period is likely to be beneficial and poses minimal risk of increased postoperative complications.

Pain Management

Pain management in HS starts with disease control.
The multidimensional aspects of pain should be considered when dealing with pain management.
In select cases of severe pain, use of individualized, carefully prescribed short-acting opioid analgesics may be needed.
Recommend that chronic pain be managed according to the World Health Organization pain ladder.

Light, Laser, and Energy SSources

An Nd:YAG laser is recommended in patients with Hurley stage II or /III disease on the basis RCT and case series data and in patients with Hurley stage I disease on the basis of expert consensus.
Other wavelengths that are used for follicular destruction are recommended on the basis of lower-quality evidence.
CO2 laser excision is recommended in patients with Hurley stage II or III disease with fibrotic sinus tracts.
External beam radiation and PDT have a limited role in the management of patients with HS.

Recommendation Grading




Hidradenitis Suppurativa- Diagnosis, Evaluation and that Use of Complementary and Procedural Management

Authoring Organization

Publication Month/Year

July 1, 2019

Last Updated Month/Year

June 30, 2022

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings


Intended Users

Physician, nurse, nurse practitioner, physician assistant


Assessment and screening, Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D017497 - Hidradenitis Suppurativa


adalimumab, infliximab, clindamycin, spironolactone, laser photocoagulation, ertapenem, comorbidities, Hidradenitis suppurativa, acne inversa, carbon dioxide laser, Nd:YAG, oral contraceptive pills, finasteride


Number of Source Documents
Literature Search Start Date
March 16, 2017
Literature Search End Date
December 1, 2018