Supplementary Material for: Proposed Definitions of Typical Lesions in Hidradenitis Suppurativa

Background: Although not rare, hidradenitis suppurativa (HS) is often under-recognized by physicians. The diagnosis of HS is clinical via the recognition of lesions typical of the disease, but universally accepted definitions of these latter are currently lacking, which means that certain severity scores employed for HS classification/management are used differently by different physicians. Our aim was to develop a set of descriptive definitions and associated images of HS lesions, in order to enable doctors to better recognize and evaluate the disease. Methods: MEDLINE-available literature and dermatological textbooks on HS morphology were retrieved (January 1996 to February 2016). A preliminary set of definitions of HS typical lesions was created, including 10 terms. Each term was associated with a pathophysiological classification and an image. This preliminary set was shown during the 5th Conference of the European HS Foundation (EHSF). The physicians attending the event were invited to vote on each term and make comments via a voting sheet. Results: A total of 81 physicians answered the questionnaire. Their agreement/disagreement rates and comments were used to obtain a revised set of definitions and images. Pathophysiological classifications were dropped. Conclusion: A user-friendly set of definitions/images of HS typical lesions was proposed and will need to be validated by further studies. This set could ultimately serve as a tool to better recognize, score, and assess treatment efficacy.

背景：化脓性汗腺炎（hidradenitis suppurativa, HS）虽非罕见疾病，但常被临床医师漏诊。HS的临床诊断依赖于对典型皮损的识别，但目前尚无针对该病皮损的公认统一定义，这导致不同医师对HS分类与管理中使用的部分严重程度评分的应用方式存在差异。本研究旨在建立一套HS皮损的描述性定义及配套图像，以助力临床医师更好地识别与评估该病。
方法：检索1996年1月至2016年2月期间MEDLINE收录的相关文献及皮肤病学教科书中关于HS皮损形态学的内容。初步构建了包含10个术语的HS典型皮损定义集，每个术语均关联病理生理学分类及对应图像。该初步定义集在欧洲HS基金会（European HS Foundation, EHSF）第五届会议上进行展示，并邀请参会医师通过投票表对各术语进行投票并提出修改意见。
结果：本次调研共回收81份医师有效问卷。研究团队基于参会医师的同意/反对率及反馈意见，对定义集及配套图像进行了修订，并移除了原有的病理生理学分类模块。
结论：本研究提出了一套易于使用的HS典型皮损定义与图像集，后续尚需更多研究对其进行验证。该定义集未来可作为标准化工具，用于提升HS的识别、病情评分及治疗效果评估能力。