Departments of Dermatology, Venereology, Allergology and Immunology, Staedtisches Klinikum Dessau, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Dessau, Germany.
Hidradenitis Suppurativa Foundation e.V., Dessau, Germany.
J Dtsch Dermatol Ges. 2024 Jun;22(6):868-889. doi: 10.1111/ddg.15412. Epub 2024 May 21.
The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method.
德国 S2k 指南关于化脓性汗腺炎/反向痤疮（HS/AI）旨在为选择/实施适当/充分的治疗提供可接受的决策辅助。HS/AI 是一种慢性复发性、炎症性、潜在毁容性的终末毛囊-腺体疾病，伴有身体富含顶泌汗腺区域的疼痛性炎症病变。德国的时点患病率为 0.3%，诊断延迟 10.0±9.6 年。毛囊-腺体装置的角质形成细胞的异常分化和伴随的炎症形成了中心发病机制基础。原发性 HS/AI 病变是炎症性结节、脓肿和引流性隧道。在过去 6 个月中，在好发部位至少有 2 个病变复发，HS/AI 的准确率为 97%。HS/AI 患者的生活质量显著下降。为了做出正确的治疗决策，应使用经过验证的工具（如国际化脓性汗腺炎严重程度评分系统（IHS4））进行分类和活动评估。根据可检测炎症的程度，HS/AI 分为两种形式：活动期、炎症性（根据 IHS4 分为轻度、中度和重度）和主要非炎症性（Hurley 分级 I、II 和 III）HS/AI。口服四环素或克林霉素 5 天静脉治疗与克林霉素/利福平的疗效相当。皮下注射阿达木单抗、司库奇尤单抗和倍美替尼已被批准用于治疗 HS/AI。各种手术方法适用于主要非炎症性疾病形式。药物/手术联合被认为是一种整体治疗方法。
