Published in JAAD
The joint AAD and HS Foundation guidelines for hidradenitis suppurativa are here.
Thirty-seven recommendations covering topical, antibiotic, hormonal, biologic, procedural, and supportive management. Search them, filter them by strength and certainty, and use them in clinic.
Start where you practice
Dermatology
The full recommendation set, the dosing and monitoring tables, and the evidence behind each one.
Primary care, OB/GYN, emergency, and urgent care
Recognition, staging, what to start now, and when to refer.
Payers and health systems
Strength and certainty ratings mapped to coverage decisions, in one table.
Recommendation finder
Look up a therapy
Typing returns the recommendation, its strength, and the certainty of evidence behind it.
Topical clindamycin 1%For patients with HS, we conditionally recommend topical clindamycin.Conditional Low certaintyTopical resorcinol 10-15%For patients with HS, we conditionally recommend topical resorcinol.Conditional Low certaintyTopical ruxolitinib 1.5% creamFor patients with HS, we conditionally recommend topical ruxolitinib.Conditional Low certaintyDoxycyclineFor patients with HS, we conditionally recommend doxycycline.Conditional Very Low certaintyTetracyclineFor patients with HS, we conditionally recommend tetracycline.Conditional Very Low certaintyClindamycin with rifampinFor patients with HS, we conditionally recommend clindamycin in combination with rifampin.Conditional Very Low certaintyErtapenemFor patients with moderate to severe HS, we conditionally recommend ertapenem.Conditional Very Low certaintySpironolactoneFor patients with HS, we conditionally recommend spironolactone.Conditional Very Low certaintyAcitretinFor patients with HS, we conditionally recommend against acitretin.Conditional Very Low certaintyIsotretinoinFor patients with HS, we conditionally recommend against isotretinoin.Conditional Very Low certaintyAdalimumabFor patients with moderate to severe HS, we recommend adalimumab.Strong Moderate certaintyAdalimumab continued perioperativelyFor patients with moderate to severe HS receiving adalimumab and undergoing surgery, we conditionally recommend continuing adalimumab.Conditional Low certaintyBimekizumabFor patients with moderate to severe HS, we recommend bimekizumab.Strong Moderate certaintyInfliximabFor patients with moderate to severe HS, we recommend infliximab.Strong Low certaintySecukinumabFor patients with moderate to severe HS, we recommend secukinumab.Strong Moderate certaintyEtanerceptFor patients with HS, we conditionally recommend against etanercept.Conditional Very Low certaintyGuselkumabFor patients with HS, we conditionally recommend against guselkumab.Conditional Low certaintyRisankizumabFor patients with HS, we conditionally recommend against risankizumab.Conditional Low certaintyVilobelimabFor patients with HS, we conditionally recommend against vilobelimab.Conditional Low certaintyUpadacitinibFor patients with moderate to severe HS, we conditionally recommend upadacitinib.Conditional Low certaintyShort-term systemic corticosteroidsFor patients with moderate to severe HS, we conditionally recommend short-term systemic corticosteroids.Conditional Very Low certaintyMethotrexateFor patients with HS, we conditionally recommend against methotrexate as active therapy. Remark: methotrexate may be used to prevent or manage anti-drug antibodies in patients receiving TNF inhibitors.Conditional Very Low certaintyAzathioprineFor patients with HS, we conditionally recommend against azathioprine as active therapy. Remark: azathioprine may be used to prevent or manage anti-drug antibodies in patients receiving TNF inhibitors.Conditional Very Low certaintyAvacopanFor patients with HS, we conditionally recommend against avacopan.Conditional Low certaintyDeroofingFor patients with HS, we conditionally recommend deroofing to treat recurrent or persistently symptomatic lesions.Conditional Very Low certaintyIncision and drainageFor patients with HS, we conditionally recommend incision and drainage to treat acutely painful abscesses.Conditional Very Low certaintyLesional and regional excisionFor patients with HS with persistent or recurrent symptomatic lesions, we conditionally recommend lesional or regional excision.Conditional Very Low certaintyLaser hair removalFor patients with HS, we conditionally recommend laser hair removal.Conditional Very Low certaintyBotulinum toxinFor patients with HS, we conditionally recommend botulinum toxin.Conditional Very Low certaintyIntralesional triamcinolone acetonideFor patients with HS, we conditionally recommend intralesional triamcinolone acetonide to treat acutely painful lesions.Conditional Very Low certaintyAdjunctive hyperbaric oxygen therapyFor patients with HS on systemic antibiotic therapy, we conditionally recommend adjunctive hyperbaric oxygen therapy.Conditional Very Low certaintyRadiotherapy in pediatric and adolescent patientsFor pediatric and adolescent patients with HS, we recommend against radiotherapy for the management of HS.Good Practice StatementRoutine pain assessmentClinicians should routinely ask patients with HS about pain as part of clinical assessment.Good Practice StatementSupportive pain managementFor patients with HS, we conditionally recommend supportive pain management in combination with disease-directed therapy. Remark: Clinicians may consider HS pain chronicity, character, and severity when selecting analgesics for pain.Conditional Very Low certaintyTobacco cessationFor patients with HS, we conditionally recommend tobacco cessation to improve response to disease-directed therapies.Conditional Very Low certaintyAdjunctive oral zincFor patients with HS, we conditionally recommend adjunctive oral zinc supplement under clinician guidance.Conditional Very Low certaintyVitamin D repletionFor patients with HS and vitamin D deficiency or insufficiency, we conditionally recommend vitamin D repletion under clinician guidance.Conditional Very Low certaintyChlorhexidine: evaluated, but the guidelines make no recommendation.Benzoyl peroxide: evaluated, but the guidelines make no recommendation.Topical antiseptics: evaluated, but the guidelines make no recommendation.Amoxicillin-clavulanate: evaluated, but the guidelines make no recommendation.Clindamycin monotherapy: evaluated, but the guidelines make no recommendation.Dapsone: evaluated, but the guidelines make no recommendation.Ofloxacin plus clindamycin: evaluated, but the guidelines make no recommendation.Metronidazole, rifampin plus moxifloxacin: evaluated, but the guidelines make no recommendation.Dalbavancin: evaluated, but the guidelines make no recommendation.Linezolid: evaluated, but the guidelines make no recommendation.Combination oral contraceptive pills: evaluated, but the guidelines make no recommendation.Finasteride: evaluated, but the guidelines make no recommendation.Metformin: evaluated, but the guidelines make no recommendation.Anakinra: evaluated, but the guidelines make no recommendation.Ixekizumab: evaluated, but the guidelines make no recommendation.Spesolimab: evaluated, but the guidelines make no recommendation.Ustekinumab: evaluated, but the guidelines make no recommendation.Colchicine: evaluated, but the guidelines make no recommendation.Cyclosporine: evaluated, but the guidelines make no recommendation.Hydroxychloroquine: evaluated, but the guidelines make no recommendation.Apremilast: evaluated, but the guidelines make no recommendation.Brepocitinib: evaluated, but the guidelines make no recommendation.Roflumilast: evaluated, but the guidelines make no recommendation.Cryotherapy: evaluated, but the guidelines make no recommendation.Intense pulsed light: evaluated, but the guidelines make no recommendation.Radiofrequency: evaluated, but the guidelines make no recommendation.Microwave ablation: evaluated, but the guidelines make no recommendation.Photodynamic therapy: evaluated, but the guidelines make no recommendation.Intralesional photodynamic therapy: evaluated, but the guidelines make no recommendation.Sclerotherapy: evaluated, but the guidelines make no recommendation.Radiotherapy in adults: evaluated, but the guidelines make no recommendation.Specific wound care regimens: evaluated, but the guidelines make no recommendation.GLP-1 and GLP-1/GIP receptor agonists: evaluated, but the guidelines make no recommendation.Bariatric surgery: evaluated, but the guidelines make no recommendation.Intermittent fasting: evaluated, but the guidelines make no recommendation.Mediterranean diet: evaluated, but the guidelines make no recommendation.Yeast exclusion diet: evaluated, but the guidelines make no recommendation.Dairy-free diet: evaluated, but the guidelines make no recommendation.Myo-inositol, liposomal magnesium and folic acid supplement: evaluated, but the guidelines make no recommendation.Staphage lysate: evaluated, but the guidelines make no recommendation.
No matching recommendations.
See all resultsTraining
How to Treat HS Micro Learning: learn the guidelines in about an hour.
Four modules, about 15 minutes each, with five questions at the end of each one. Taught by members of the guidelines workgroup.
Module 1
How to read these guidelines
How to read the guidelines: what they cover, why strength and certainty are different things, and why “no recommendation” is not a recommendation against.
Module 2
Topicals and early disease
Mild to moderate disease and the three recommended topicals, for clinicians in and outside dermatology.
Module 3
Escalation
Moderate to severe disease: the four biologics with a strong recommendation, and what the guidelines say not to reach for.
Module 4
Pain and supportive care
Pain assessment and the supportive recommendations that apply at every severity.
Print materials: take it into a clinic or other setting
The guidelines in a format you'll actually use: a quick reference for the exam room. Print it, save it to your phone, or share it with your team.
Coverage and policy
For payers and health systems: four therapies carry a strong recommendation.
Strength of recommendation and certainty of evidence are reported separately for every therapy. The payer view puts both in one table, along with the conditional recommendations resting on low-certainty evidence.
| Therapy | Class | Population | Strength | Certainty |
|---|---|---|---|---|
| Adalimumab | TNF inhibitor | Moderate to severe HS | Strong | Moderate |
| Bimekizumab | IL-17A/F inhibitor | Moderate to severe HS | Strong | Moderate |
| Infliximab | TNF inhibitor | Moderate to severe HS | Strong | Low |
| Secukinumab | IL-17A inhibitor | Moderate to severe HS | Strong | Moderate |
Insights
Perspectives from the field
Essays from the HS Foundation board and the guidelines workgroup on what the guidelines change, what they do not, and what comes next.
Phase 2
HSF Clinician Directory
Patients and referring clinicians will be able to search for clinicians who treat HS, by location and specialty.
HS Foundation
The organization behind these guidelines, dedicated to improving the lives of people with HS through research, education, and patient advocacy.
Refer a patient to HS Buddies
A free program that pairs patients with a peer who lives with HS and understands what they're going through. Order printed referral cards to keep in your clinic and hand to patients who could use the support.
Get updates on the guidelines
We will email you when recommendations change.