Joint AAD & HS Foundation clinical guidelines
Guidelines of Care for the Management of Hidradenitis Suppurativa
Every recommendation with its strength, certainty of evidence, dosing, and monitoring.
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4strong recommendations
2good practice statements, treated as strong
37recommendations in total
40therapies where evidence generation is needed
Research gaps
The workgroup searched the literature for all available therapeutic interventions for HS. For the therapies below, the available evidence was insufficient to make a recommendation either for or against.
No recommendation is not a recommendation against. These are areas where evidence generation is needed, not therapies the guidelines advise against, and several are in common use. For each one the evidence was too limited, too heterogeneous, or too prone to bias to support a recommendation either way.
Showing 40 of 40 therapies
Topical therapies
Systemic antibiotics
Hormonal therapies
Biologics
Systemic therapies
Procedural interventions
Wound care
Weight reduction
Diet
Complementary and alternative medicine
No therapies match these filters.
No recommendation
Note
The guidelines note that oral clindamycin monotherapy versus clindamycin plus rifampin showed no difference in IHS4 at 8 weeks in 60 patients, and calls for prospective study of monotherapy.
No recommendation Discussed in body text
Note
One RCT combining metformin with doxycycline showed no significant effect on IHS4 or HiSCR-50 at 24 weeks. Three case series in 94 patients reported subjective response in 68%, but were prone to substantial bias. Long-term cardiometabolic effects should be examined.
No recommendation Discussed in body text
Note
Four case series of heterogeneous modalities and doses in 109 patients. Small samples, heterogeneous interventions and outcome assessment, and moderate to high risk of bias limited confidence. Note that radiotherapy carries a separate good practice statement against use in pediatric and adolescent patients.
No recommendation
Note
Wound care is described as necessary and beneficial, but no specific regimen is supported in either usual or postoperative settings. Gentamycin sponge, silver hydrofiber, polyurethane foam, oxygen-enriched dressings and low negative pressure wound therapy were each studied without demonstrating advantage. Outcome measures and best practices remain an open research question.
No recommendation Frequently asked in practice
Note
Seven non-randomized studies were identified in patients with HS and obesity. In one cohort, 27 of 45 patients on semaglutide reached HiSCR-50 at 12 months. The workgroup determined the evidence is insufficient to recommend these agents for HS treatment. Weight management remains important for cardiometabolic risk reduction.
No recommendation Discussed in body text
Note
Associated with lower self-reported severity and mean DLQI than nutritional care in a 19-patient cohort, and with fewer affected body sites in a 45-patient registry study. Evidence remains insufficient to render a recommendation.
No recommendation
Note
Mean IHS4 fell modestly from 11.0 to 10.2 in 55 patients who fasted during Ramadan.
No recommendation
Note
Associations between adherence and HS severity were inconsistent across studies.
No recommendation
Note
Self-reported improvement and reduced pain were reported, but low and poorly reported adherence limited generalizability and real-world feasibility.
No recommendation
Note
Reported to improve HS anecdotally. Data were prone to substantial bias from small samples, absent controls and insufficient attention to adherence.