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Dermatology

Surgical Procedural Definitions for Hidradenitis Suppurativa Developed by Expert Delphi Consensus

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JAMA Dermatology

Published Online: February 22, 2023

Consensus Statement

Article Information and Disclosures

Helen Bui, MD¹;

Falk G. Bechara, MD²;

Ralph George, MD³;

Stephanie Goldberg, MD⁴;

Iltefat Hamzavi, MD⁵;

Joslyn S. Kirby, MD, MEd, MS⁶;

Drew Saylor, MD⁷;

Christopher J. Sayed, MD^1,8

Author Affiliations

¹University of North Carolina School of Medicine, Chapel Hill
²Department of Dermatologic Surgery, Ruhr-University, Bochum, Germany
³Department of Surgery, University of Toronto, Toronto, Canada
⁴Department of Surgery, Mary Washington Healthcare, Fredericksburg, Virginia
⁵Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
⁶Department of Dermatology, Pennsylvania State Milton S Hershey Medical Center, Hershey
⁷Department of Dermatology, University of California, San Francisco, San Francisco
⁸Department of Dermatology, University of North Carolina School of Medicine, Chapel Hill

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Key Points

Question Can standardized definitions of surgical interventions in hidradenitis suppurativa (HS) be established by a panel of international experts?

Findings Following a 2-round modified Delphi consensus method, including 50 international HS experts in the first round and 33 in the second, standardized nomenclature for surgical consensus was reached on procedures commonly used in HS interventions.

Meaning The reported standardized definitions serve to describe surgical interventions that will allow for more uniform reporting of procedures for HS management and research.

Abstract

Importance Various surgical approaches for hidradenitis suppurativa (HS) have been described in the literature, but the nomenclature is inconsistent. Excisions have been described as wide, local, radical, and regional with variable descriptions of margins. Deroofing procedures have been described with various approaches though descriptions of the approach are generally more uniform. No international consensus has been formed to globally standardize terminology for HS surgical procedures. Lack of such agreement may contribute to misunderstanding or misclassification in HS procedural research studies and impair clear communication among clinicians or between clinicians and patients.

Objective To create a set of standard definitions for HS surgical procedures.

Design, Setting, and Participants This consensus agreement study was conducted from January to May 2021 using the modified Delphi consensus method to reach agreement among a group of international HS experts regarding standardized definitions for an initial set of HS surgical terms, including “incision and drainage,” “deroofing/unroofing,” “excision,” “lesional excision,” and “regional excision,” ultimately expanded to 10 terms. Provisional definitions were drafted based on existing literature and discussion among an expert 8-member steering committee. Online surveys were disseminated to members of the HS Foundation, direct contacts of the expert panel, and the HSPlace listserv to reach physicians with considerable experience with HS surgery. Consensus was defined as greater than 70% agreement to accept a definition.

Results In the first and second modified Delphi round, 50 and 33 experts participated, respectively. Ten surgical procedural terms and definitions reached consensus with greater than 80% agreement. Overall, the term “local” excision was abandoned and replaced with the descriptors “lesional” or “regional” excision. Of note, “regional” replaced the terms “wide” and “radical” excision. Furthermore, modifiers such as “partial” vs “complete” should also be included when describing surgical procedures. A combination of these terms helped formulate the final glossary of HS surgical procedural definitions.

Conclusion and Relevance An international group of HS experts agreed on a set of definitions describing surgical procedures frequently used by clinicians and in the literature. The standardization and application of such definitions are vital to allow for accurate communication, reporting consistency, and uniform data collection and study design in the future.

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Article Information

Accepted for Publication: December 27, 2022.

Published Online: February 22, 2023. doi:10.1001/jamadermatol.2022.6266

Corresponding Author: Helen Bui, MD, UNC Hospitals, 101 Manning Drive, Chapel Hill, NC 27514 (helen.bui@unchealth.unc.edu).

Author Contributions: Drs Bui and Sayed had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bui, Bechara, George, Goldberg, Saylor, Sayed.

Acquisition, analysis, or interpretation of data: Bui, Bechara, George, Goldberg, Hamzavi, Kirby, Sayed.

Drafting of the manuscript: Bui, Bechara, Hamzavi, Saylor, Sayed.

Critical revision of the manuscript for important intellectual content: Bui, Bechara, George, Goldberg, Hamzavi, Kirby, Sayed.

Statistical analysis: Bui.

Administrative, technical, or material support: Bui, Bechara, Goldberg, Hamzavi, Sayed.

Supervision: Bechara, Goldberg, Kirby, Sayed.

Conflict of Interest Disclosures: Dr George reported personal fees from AbbVie unrelated to topic outside the submitted work. Dr Hamzavi reported personal fees from Incyte, Abbvie, grants from Pfizer, personal fees from UCB, Jansen, Boerhinger Ingelheim, Novartis, and nonfinancial support from Lenicura during the conduct of the study. Dr Kirby reported personal fees from AbbVie, ChemoCentryx, grants from Incyte, personal fees from Janssen, Novartis, and UCB outside the submitted work. Dr Sayed reported grants from AbbVie Education grant, investigator fees to institution, personal fees from AbbVie speaking, consulting, personal fees from Novartis Speaking, consulting, grants from Novartis Investigator fees paid to institution, grants from UCB Investigator fees paid to institution, personal fees from UCB Consulting fees, grants from Incyte Investigational fees paid to institution, grants from Chemocentryx Investigator fees paid to institution, grants from InflaRx Investigator fees paid to institution, personal fees from InflaRx Consulting, and personal fees from Amaris Consulting outside the submitted work; and I am a directing member of the HS Foundation. No other disclosures were reported.

Funding/Support: National Institute of Health, National Institute of Arthritis, Musculoskeletal, and Skin Diseases grant number 1R21AR075996-01A1. We thank the National Institute of Health, National Institute of Arthritis, Musculoskeletal, and Skin Diseases grant number 1R21AR075996-01A1 for supporting the design and conduct of the study; collection, management, analysis, and interpretation of the data.

Role of the Funder/Sponsor: The National Institute of Health and the National Institute of Arthritis, Musculoskeletal, and Skin Diseases had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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