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Clinical practice is variable, and there is a need for international, evidence\u2010based and easily applicable consensus on HS management. We report here the findings of a systematic literature review, which were subsequently used as a basis for the development of international consensus recommendations for the management of patients with HS. A systematic literature review was performed for each of nine clinical questions in HS (defined by an expert steering committee), covering comorbidity assessment, therapy (medical, surgical and combinations) and response to treatment. Included articles underwent data extraction and were graded according to the Oxford Centre for Evidence\u2010based Medicine criteria. Evidence\u2010based recommendations were then drafted, refined and voted upon, using a modified Delphi process. Overall, 5310 articles were screened, 171 articles were analysed, and 65 were used to derive recommendations. These articles included six randomized controlled trials plus cohort studies and case series. The highest level of evidence concerned dosing recommendations for topical clindamycin in mild disease (with systemic tetracyclines for more frequent\/widespread lesions) and biologic therapy (especially adalimumab) as second\u2010line agents (following conventional therapy failure). Good\u2010quality evidence was available for the hidradenitis suppurativa clinical response (HiSCR) as a dichotomous outcome measure in inflammatory areas under treatment. Lower\u2010level evidence supported recommendations for topical triclosan and oral zinc in mild\u2010to\u2010moderate HS, systemic clindamycin and rifampicin in moderate HS and intravenous ertapenem in selected patients with more severe disease. Intralesional or systemic steroids may also be considered. Local surgical excision is suggested for mild\u2010to\u2010moderate HS, with wide excision for more extensive disease. Despite a paucity of good\u2010quality data on management decisions in HS, this systematic review has enabled the development of robust and easily applicable clinical recommendations for international physicians based on graded evidence.<\/jats:p>","DOI":"10.1111\/jdv.15233","type":"journal-article","created":{"date-parts":[[2018,9,3]],"date-time":"2018-09-03T10:14:35Z","timestamp":1535969675000},"page":"19-31","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":223,"title":["Hidradenitis suppurativa\/acne inversa: a practical framework for treatment optimization \u2013 systematic review and recommendations from the HS ALLIANCE working group"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1646-2608","authenticated-orcid":false,"given":"C.C.","family":"Zouboulis","sequence":"first","affiliation":[{"name":"Departments of Dermatology, Venereology, Allergology and Immunology Dessau Medical Center 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Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Hughes","sequence":"additional","affiliation":[{"name":"Department of Dermatology St Vincent's University Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.B.","family":"Kimball","sequence":"additional","affiliation":[{"name":"Department of Dermatology Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Kirby","sequence":"additional","affiliation":[{"name":"Department of Dermatology St Vincent's University Hospital Dublin Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Martorell","sequence":"additional","affiliation":[{"name":"Department of Dermatology Hospital de Manises Valencia Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Podda","sequence":"additional","affiliation":[{"name":"Department of Dermatology Medical 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