Abstract:

Importance: Standard histological assessment of tissue from patients with Hidradenitis Suppurative (HS) is vital for identification of lesion types in clinical trial setting and communication about the condition. A recent consensus statement was published outlining morphological definitions, but no consensus has been reached regarding clinical characterization and examination of HS tissue samples. Objective: To establish and validate a protocol for the examination of HS tissue specimens and a protocol for the clinical characterization of HS tissue samples. Methods: This study was conducted from January 2022 to May 2022. A Delphi study technique was used to assess agreement and then resolve disagreement on HS histological terminology and clinical characterization of tissue. After the initial preparation phase, the process consisted of two rounds. In each round, participants reviewed and provided feedback regarding a protocol for examination of tissue samples from patients with HS and a protocol for the clinical characterization of tissue samples from patients with HS. The protocols were formatted as synoptic reports. Included histologic parameters were cystically dilated follicle, folliculitis, abscess, sinus tract granulation tissue, sinus tract lined by squamous epithelium, fibrosis, hypertrophic scar, keloid, granulomas, hidradenitis, epidermal alterations, and inflammation. Results: A total of 7 experts participated (5 dermatologists and 2 fellowship-trained dermatopathologists). Conclusions and Relevance: An international group of experts agreed on protocols to examine and clinically characterize tissue samples form HS patients. The protocols were formatted as a synoptic report. These international consensus protocols are needed to support consistency of histologic examination, quantification in clinical trials, and clustering of patients based off histologic subtypes. This will further aide in identifying the pathologic process behind HS.

Financial Disclosure:
No current or relevant financial relationships exist.

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Ashwath Sampath, MD