Infectious Disease Screening prior to Systemic Immunomodulatory Therapy in Hidradenitis Suppurativa: Consensus Guidelines from the Asia-Pacific Hidradenitis Suppurativa Foundation
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Published:2023-11-14
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Volume:
Page:1-13
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ISSN:1018-8665
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Container-title:Dermatology
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language:en
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Short-container-title:Dermatology
Author:
Kozera Emily K.,Porter Martina,Paek So Yeon,Mintoff Dillon,McMeniman Erin,Oon Hazel H.,Chandran Nisha Suyien,Glasenhardt Katalin,Ring Hans Christian,Frew John W.
Abstract
<b><i>Background:</i></b> Current infectious disease screening recommendations for hidradenitis suppurativa (HS) are adopted from recommendations in chronic plaque psoriasis. No HS-specific guidelines for infectious disease screening prior to immunomodulatory therapy have been developed. <b><i>Objectives:</i></b> The aim of the study was to establish an expert Delphi consensus of recommendations regarding infectious disease screening prior to systemic immunomodulatory therapy in HS. <b><i>Methods:</i></b> Participants were identified via recent publications in the field and were sent a questionnaire regarding infectious diseases encountered in the setting of HS, and opinions regarding infectious disease screening prior to various systemic immunomodulatory therapies. All questions were informed by a systematic literature review regarding infections exacerbated or precipitated by immunomodulatory therapy. Questionnaire responses were followed by round-table discussion with a core group of 8 experts followed by a final round of questionnaires resulting in achievement of consensus. <b><i>Results:</i></b> 44 expert HS physicians from 12 countries on 5 continents participated in the development of the expert consensus recommendations. Consensus recommendations include screening for hepatitis B, hepatitis C and tuberculosis in all individuals with HS prior to therapy. All immunomodulatory therapies (biologic and systemic immunosuppressant therapy) should be preceded by infectious disease screening including patient and location-specific considerations for endemic local diseases and high-risk activities and occupations. Clinical assessment has a significant role in determining the need for laboratory screening in the setting of many uncommon or tropical diseases such as leprosy, leishmaniasis and strongyloidiasis. <b><i>Conclusions:</i></b> The presented consensus recommendations are the first specifically developed for pre-treatment infectious disease screening in HS.