Vestnik dermatologii i venerologiiVestnik dermatologii i venerologiiВестник дерматологии и венерологии0042-46092313-6294Rossijskoe Obschestvo Dermatovenerologov i Kosmetologov1673910.25208/vdv16739REVIEWSОБЗОР ЛИТЕРАТУРЫResearch ArticleHidradenitis suppurativa: review of international clinical guidelines for the diagnosis and treatment of the diseaseГнойный гидраденит: обзор международных клинических рекомендаций по диагностике и лечению заболеванияhttps://orcid.org/0000-0002-0387-54814417-9117KhairutdinovVladislav R.ХайрутдиновВладислав Ринатович
Russian Federation

MD, Dr. Sci. (Med.), Assistant Professor

д.м.н., доцент

haric03@list.ruhttps://orcid.org/0000-0003-0017-621X5420-5508BurovaSofia A.БуроваСофия Алексеевна
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

doctorburova@mail.ruhttps://orcid.org/0000-0003-2482-17542500-7989OlisovaOlga Yu.ОлисоваОльга Юрьевна
Russian Federation

MD, Dr. Sci. (Med.), Professor, Corresponding Member of the Russian Academy of Sciences

д.м.н., профессор, член-корреспондент РАН

olisovaolga@mail.ruhttps://orcid.org/0000-0001-7610-60616807-7137SokolovskiyEvgeny V.СоколовскийЕвгений Владиславович
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

s40@mail.ruhttps://orcid.org/0000-0001-6353-66443470-9306KokhanMuza M.КоханМуза Михайловна
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

mkokhan@yandex.ruhttps://orcid.org/0000-0003-2995-42496628-1260KotrekhovaLiubov P.КотреховаЛюбовь Павловна
Russian Federation

MD, Cand. Sci. (Med.); Associate Professor

к.м.н., доцент

zurupalubov@inbox.ruhttps://orcid.org/0000-0003-3039-77696222-8684RakhmatulinaMargarita R.РахматулинаМаргарита Рафиковна
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

rahmatulina@cnikvi.ruhttps://orcid.org/0000-0002-9458-08722287-5062SamtsovAlexey V.СамцовАлексей Викторович
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

avsamtsov@mail.ruhttps://orcid.org/0000-0002-6378-85829094-9688AraviiskaiaElena R.АравийскаяЕлена Роальдовна
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

arelenar@mail.ruhttps://orcid.org/0000-0002-2246-13211419-2147PirogovaAnna S.ПироговаАнна Сергеевна
Russian Federation

MD, PhD, Student

аспирант

annese@mail.ruS.M. Kirov Military Medical AcademyВоенно-медицинская академия им. С.М. КироваNational Academy of MycologyНациональная академия микологииI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет имени И.М. Сеченова (Сеченовский Университет)Pavlov First Saint Petersburg State Medical University (Pavlov University)Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. ПавловаUral Research Institute of Dermatovenereology and ImmunopathologyУральский научно-исследовательский институт дерматовенерологии и иммунопатологииMechnikov North-West State Medical UniversityСеверо-Западный государственный медицинский университет имени И.И. МечниковаState Research Center of Dermatovenereology and CosmetologyГосударственный научный центр дерматовенерологии и косметологии180620241107202410037161211202322052024Copyright ©; 2024, Khairutdinov V.R., Burova S.A., Olisova O.Y., Sokolovskiy E.V., Kokhan M.M., Kotrekhova L.P., Rakhmatulina M.R., Samtsov A.V., Araviiskaia E.R., Pirogova A.S.Copyright ©; 2024, Хайрутдинов В.Р., Бурова С.А., Олисова О.Ю., Соколовский Е.В., Кохан М.М., Котрехова Л.П., Рахматулина М.Р., Самцов А.В., Аравийская Е.Р., Пирогова А.С.2024Khairutdinov V.R., Burova S.A., Olisova O.Y., Sokolovskiy E.V., Kokhan M.M., Kotrekhova L.P., Rakhmatulina M.R., Samtsov A.V., Araviiskaia E.R., Pirogova A.S.Хайрутдинов В.Р., Бурова С.А., Олисова О.Ю., Соколовский Е.В., Кохан М.М., Котрехова Л.П., Рахматулина М.Р., Самцов А.В., Аравийская Е.Р., Пирогова А.С.https://creativecommons.org/licenses/by-nc/4.0https://vestnikdv.ru/jour/article/view/16739

Background. Hidradenitis suppurativa hidradenitis is a chronic recurrent inflammatory skin disease that develops after puberty and is characterized by the appearance of recurrent painful nodes, abscesses, the formation of fistula passages and scars on skin areas rich in apocrine sweat glands. Treatment of purulent hidradenitis is aimed at suppressing inflammation, relieving pain, preventing the formation of fistulas and scars.

The objectives of this review. Summarize the information in the published international clinical guidelines for the diagnosis and treatment of purulent hidradenitis, their comprehensive assessment and comparison with each other.

Methods. In the period from December 2022 to February 2023, scientific articles were searched in the PubMed database of the National Center for Biotechnological Information. Inclusion criteria: scientific articles in English, without date restrictions; interdisciplinary publications of specialists in which dermatovenereologists participated.

Results. The analysis of the existing relevant international clinical recommendations for the diagnosis and treatment of purulent hidradenitis indicates the absence of specific treatment schemes and algorithms, criteria for evaluating the effectiveness of therapy. In the treatment of purulent hidradenitis, the use of external keratolytics, antiseptics and antibiotics is recommended. Among systemic drugs, antibiotics, retinoids, immunosuppressive agents, hormonal drugs are used. The highest therapeutic efficacy in patients with purulent hidradenitis was shown by genetically engineered drugs that inhibit TNF-α and IL-17A.

Conclusions. Patients with purulent hidradenitis require various treatment approaches, including a variety of surgical interventions, depending on the stage, severity, prescription of the disease and the general condition of the patient. The basic principle is the individual selection of the treatment method for a particular patient. In this regard, there is a need to develop domestic clinical guidelines for the management of patients with purulent hidradenitis.

Обоснование. Гнойный гидраденит (ГГ) — хроническое рецидивирующее воспалительное заболевание кожи, которое развивается после полового созревания и характеризуется появлением на участках кожи, богатых апокриновыми потовыми железами, рецидивирующих болезненных узлов, абсцессов, формированием свищевых ходов и рубцов. Лечение ГГ направлено на подавление воспаления, купирование боли и предупреждение формирования свищей и рубцов.

Цель настоящего обзора. Обобщение сведений в опубликованных международных клинических рекомендациях по диагностике и лечению ГГ, их всесторонняя оценка и сравнение между собой.

Методы. В период с декабря 2022 по февраль 2023 г. осуществлялся поиск научных статей в базе данных PubMed Национального центра биотехнологической информации. Критерии включения: научные статьи на английском языке без ограничений по дате; междисциплинарные публикации специалистов, в которых участвовали врачи-дерматовенерологи.

Результаты. Анализ существующих актуальных международных клинических рекомендаций по диагностике и лечению ГГ свидетельствует об отсутствии в них конкретных схем и алгоритмов лечения, критериев оценки эффективности проводимой терапии. В терапии ГГ рекомендовано использование наружных кератолитиков, антисептиков и антибиотиков. Среди системных препаратов применяют антибиотики, ретиноиды, иммуносупрессивные средства, гормональные препараты. Наиболее высокую терапевтическую эффективность в лечении ГГ показали генно-инженерные биологические препараты, ингибирующие ФНО-α и ИЛ-17А.

Выводы. Пациентам с ГГ в зависимости от стадии, тяжести, давности заболевания и общего состояния больного требуются различные подходы в лечении, в том числе разнообразные хирургические вмешательства. Основной принцип — индивидуальный подбор метода лечения для конкретного пациента. В связи с этим существует потребность в разработке отечественных клинических рекомендаций по ведению пациентов с ГГ.

purulent hidradenitisinverse acnetreatmentclinical recommendationsгнойный гидраденитинверсные акнелечениеклинические рекомендацииHendricks AJ, Hsiao JL, Lowes MA, Shi VY. A comparison of international management guidelines for hidradenitis suppurativa. Dermatology. 2021;237(1):81–96. doi: 10.1159/000503605Ocker L, Abu Rached N, Seifert C, Scheel C, Bechara FG. Current medical and surgical treatment of hidradenitis suppurativa-a comprehensive review. J Clin Med. 2022;11(23):7240. doi: 10.3390/jcm11237240Hurley HJ. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa and familial benign pemphigus. Surgical approach. Dermatologic Surgery, Principles and Practice. 2nd ed. N.Y.: Marcel Dekker; 1989. P. 623–646.Van der Zee HH, Jemec GBE. New insights into the diagnosis of hidradenitis suppurativa: Clinical presentations and phenotypes. J Am Acad Dermatol. 2015;73(5 Suppl 1):S23–26. doi: 10.1016/j.jaad.2015.07.047Thorlacius L, Garg A, Riis PT, Nielsen SM, Bettoli V, Ingram JR, et al. Inter-rater agreement and reliability of outcome measurement instruments and staging systems used in hidradenitis suppurativa. Br J Dermatol. 2019;181(3):483–491. doi: 10.1111/bjd.17716База данных PubMed Национального центра биотехнологической информации — National Center for Biotechnology Information, NCBI. URL: https://pubmed.ncbi.nlm.nih.gov (accessed: 17.02.2023).Zouboulis CC, Desai N, Emtestam L, Hunger RE, Ioannides D, Juhász I, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619–644. doi: 10.1111/jdv.12966Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord. 2016;17(3):343–351. doi: 10.1007/s11154-016-9328-5Hunger RE, Laffitte E, Läuchli S, Mainetti C, Mühlstädt M, Schiller P, et al. Swiss practice recommendations for the management of hidradenitis suppurativa/acne inversa. Dermatology. 2017;233(2–3):113–119. doi: 10.1159/000477459Alavi A, Lynde C, Alhusayen R, Bourcier M, Delorme I, George R, et al. Approach to the management of patients with hidradenitis suppurativa: a consensus document. J Cutan Med Surg. 2017;21(6):513–524. doi: 10.1177/1203475417716117Gulliver W, Landells ID, Morgan D, Pirzada S. Hidradenitis suppurativa: a novel model of care and an integrative strategy to adopt an orphan disease. J Cutan Med Surg. 2018;22(1):71–77. doi: 10.1177/1203475417736290Ingram JR, Collier F, Brown D, Burton T, Burton J, Chin MF, et al. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol. 2019;180(5):1009–1017. doi: 10.1111/bjd.17537Zouboulis CC, Bechara FG, Dickinson-Blok JL, Gulliver W, Horváth B, Hughes R, et al. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization — systematic review and recommendations from the HS ALLIANCE working group. J Eur Acad Dermatol Venereol. 2019;33(1):19–31. doi: 10.1111/jdv.15233Alikhan A, Sayed C, Alavi A, Alhusayen R, Brasasard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian hidradenitis suppurativa foundations: Part I: diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76–90. doi: 10.1016/j.jaad.2019.02.067Alikhan A, Sayed C, Alavi A, Alhusayen R, Brasasard A, Burkhart C, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian hidradenitis suppurativa foundations: Part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91–101. doi: 10.1016/j.jaad.2019.02.068Magalhães RF, Rivitti-Machado MC, Duarte GV, Souto R, Nunes DH, Chaves M, et al. Consensus on the treatment of hidradenitis suppurativa — Brazilian Society of Dermatology. An Bras Dermatol. 2019;94(2 Suppl 1):7–19. doi: 10.1590/abd1806-4841.20198607Simonart T. Hidradenitis suppurativa and smoking. J Am Acad Dermatol. 2010;62(1):149–150. doi: 10.1016/j.jaad.2009.08.001Boyd AS. Ichthammol revisited. Int J Dermatol. 2010;49(7):757–760. doi: 10.1111/j.1365-4632.2010.04551.xRiis PT, Boer J, Prens EP, Saunte DM, Deckers IE, Emtestam L, et al. Intralesional triamcinolone for flares of hidradenitis suppurativa (HS): a case series. J Am Acad Dermatol. 2016;75(6):1151–1155. doi: 10.1016/j.jaad.2016.06.049Albrecht J, Baine PA, Ladizinski B, Jemec GB, Bigby M. Long-term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. A critically appraised topic. Br J Dermatol. 2019;180(4):749–755. doi: 10.1111/bjd.17265Caeiro JP, Iannini PB. Moxifloxacin (Avelox): a novel fluoroquinolone with a broad spectrum of activity. Expert Rev Anti Infect Ther. 2003;1(3):363–370. doi: 10.1586/14787210.1.3.363Join-Lambert O, Coignard H, Jais JP, GuetRevillet H, Poirée S, Fraitag S, et al. Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa. Dermatology. 2011;222(1):49–58. doi: 10.1159/000321716Zhanel GG, Johanson C, Embil JM, Noreddin A, Gin A, Vercaigne L, et al. Ertapenem: review of a new carbapenem. Expert Rev Anti Infect Ther. 2005;3(1):23–39. doi: 10.1586/14787210.3.1.23Join-Lambert O, Coignard-Biehler H, Jais JP, Delage M, Guet-Revillet H, Poirée S, et al. Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients. J Antimicrob Chemother. 2016;71(2):513–520. doi: 10.1093/jac/dkv361Vossen AR, van Straalen KR, Prens EP, van der Zee HH. Menses and pregnancy affect symptoms in hidradenitis suppurativa: a cross-sectional study. J Am Acad Dermatol. 2017;76(1):155–156. doi: 10.1016/j.jaad.2016.07.024Riis PT, Ring HC, Themstrup L, Jemec GB. The role of androgens and estrogens in hidradenitis suppurativa — a systematic review. Acta Dermatovenerol Croat. 2016;24(4):239–249.Miller I, Lynggaard CD, Lophaven S, Zachariae C, Dufour DN, Jemec GB. A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa. Br J Dermatol. 2011;165(2):391–398. doi: 10.1111/j.1365-2133.2011.10339.xKimball AB, Kerdel F, Adams D, Mrowietz U, Gelfand JM, Gniadecki R, et al. Adalimumab for the treatment of moderate to severe Hidradenitis suppurativa: a parallel randomized trial. Ann Intern Med. 2012;157(12):846–855. doi: 10.7326/0003-4819-157-12-201212180-00004Kimball AB, Okun MM, Williams DA, Gottlieb AB, Papp KA, Zouboulis CC, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med. 2016;375(5):422–434. doi: 10.1056/NEJMoa1504370Davis JS, Ferreira D, Paige E, Gedye C, Boyle M. Infectious complications of biological and small molecule targeted immunomodulatory therapies. Clin Microbiol Rev. 2020;33(3):e00035-19. doi: 10.1128/CMR.00035-19Prussick L, Rothstein B, Joshipura D, Saraiya A, Turkowski Y, Abdat R, et al. Open-label, investigator-initiated, single-site exploratory trial evaluating secukinumab, an anti-interleukin-17A monoclonal antibody, for patients with moderate-to-severe hidradenitis suppurativa. Br J Dermatol. 2019;181(3):609–611. doi: 10.1111/bjd.17822Kimball AB, Jemec GBE, Alavi A, Reguiai Z, Gottlieb AB, Bechara FG, et al. Secukinumab in moderate-to-severe hidradenitis suppurativa (SUNSHINE and SUNRISE): week 16 and week 52 results of two identical, multicentre, randomised, placebo-controlled, double-blind phase 3 trials. Lancet. 2023;401(10378):747–761. doi: 10.1016/S0140-6736(23)00022-3Chawla S, Toale C, Мorris М, Тоbin А, Кavanagh D. Surgical management of hidradenitis suppurativa: a narrative review. J Clin Aesthet Dermatol. 2022;15(1):35–41.Yeroushalmi S, Ildardashty A, Elhage KG, Chung M, Bartholomew E, Hakimi M, et al. Hidradenitis suppurativa and sleep: a systematic review. Arch Dermatol Res. 2023;315(5):1409–1415. doi: 10.1007/s00403-022-02460-xCuenca-Barrales C, Montero-Vilchez T, Sanchez-Diaz M, Rodriguez-Pozo JA, Diaz-Calvillo P, Martinez-Lopez A, et al. A patterns of surgical recurrence in patients with hidradenitis suppurativa. Dermatology. 2023;239(2):255–261. doi: 10.1159/000527400Vellaichamy G, Braunberger T, Nahhas A, Hamzavi IH. Surgical procedures for hidradenitis suppurativa. Cutis. 2018;102(1):13–16.Scuderi N, Monfrecola A, Dessy L, Fabbrocini G, Megna M, Monfrecola G. Medical and surgical treatment of hidradenitis suppurativa: a review. Skin Appendage Disord. 2017;3(2):95–110. doi: 10.1159/000462979Van Hattem S, Spoo JR, Horvath B, et al. Surgical treatment of sinuses by deroofing in hidradenitis suppurativa. Dermatol Surg. 2012;38(3):494–497. doi: 10.1111/j.1524-4725.2011.02255.xZaayman M, Azhar A, Silfvast-Kaiser A, Jeong CY, Paek SY. MOdified DEroofing with scar excision (MODES Procedure) for the surgical treatment of hidradenitis Suppurativa. J Cutan Med Surg. 2023;27(1):69–71. doi: 10.1177/12034754221138246Shavit E, Pawliwec A, Alavi A, George R. The surgeon’s perspective: a retrospective study of wide local excisions taken to healthy subcutaneous fat in the management of advanced hidradenitis suppurativa. Can J Surg. 2020;63(2):E94–E99. doi: 10.1503/cjs.003119Бурова С.А. Принципиальные подходы к радикальному лечению актиномикоза и других гнойно-воспалительных заболеваний абдоминальной и параректальной локализаций. Успехи медицинской микологии. 2017;17:244–245. [Burova SA. Principal approaches to the treatment of individual actinomycosis and other purulent-inflammatory diseases of the abdominal and pararectal localization. Advances in medical mycology. 2017;17:244–245. (In Russ.)]Manfredini M, Garbarino F, Bigi L, Pellacani G, Magnoni C. Surgical and postsurgical wound care in hidradenitis suppurativa. Dermatol Ther. 2020;33(3):e13282. doi: 10.1111/dth.13282Balik E, Eren T, Bulut T, Büyükuncu Y, Bugra D, Yamaner S. Surgical approach to extensive hidradenitis suppurativa in the perineal/ perianal and gluteal regions. World J Surg. 2008;33(3):481–487. doi: 10.1007/s00268-008-9845-9Cuenca-Barrales C, Montero-Vilchez T, Sanchez-Diaz M, Rodriguez-Pozo JA, Diaz-Calvillo P, Martinez-Lopez A, et al. Patterns of surgical recurrence in patients with hidradenitis suppurativa. Dermatology. 2023;239(2):255–261. doi: 10.1159/000527400Danby F, Hazen P, Boer J. New and traditional surgical approaches to hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(5):S62–65. doi: 10.1016/j.jaad.2015.07.043Ezekwe N, Neelam R, Jones BA, Ozog DM, Hamzavi IH. Retrospective study of keloid formation after CO2 excision therapy for hidradenitis suppurativa. J Am Acad Dermatol. 2023;89(1):181–182. doi: 10.1016/j.jaad.2023.03.001Mahmoud BH, Tierney E, Hexsel CL, Pui J, Ozog DM, Hamzavi IH. Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser. J Am Acad Dermatol. 2010;62(4):637–645. doi: 10.1016/j.jaad.2009.07.048Naouri M, Maruani A, Lagrange S, Cogrel O, Servy A, Collet Vilette AM, et al. Treatment of hidradenitis suppurativa using a long-pulsed hair removal neodymium:yttrium-aluminium-garnet laser: A multicenter, prospective, randomized, intraindividual, comparative trial. J Am Acad Dermatol. 2021;84(1):203–205. doi: 10.1016/j.jaad.2020.04.117Ezekwe N, Ozog DM, Hamzavi IH. Response to: “Treatment of hidradenitis suppurativa using a long-pulsed hair removal neodymium:yttrium-aluminium-garnet laser: A multicenter, prospective, randomized, intraindividual, comparative trial”. J Am Acad Dermatol. 2022;86(2):e69–e70. doi: 10.1016/j.jaad.2021.06.890