Criteria for Hidradenitis Suppurativa Competence Centers

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic, systemic, immune-mediated disease requiring multimodal care, which is crucial for raising awareness and advancing treatment. This project aimed to establish consensus among HS experts to define HS Competence Centers (HSCC) criteria using the Delphi consensus method. METHODS: Overall, 22 global HS experts (3 patient representatives and 19 healthcare professionals [HCPs]) from 16 countries across 5 continents were invited to participate. Subsequently, a three-step Delphi polling was conducted among the HS experts from 20 May 2024 to 8 July 2024. A 50% agreement was required to reach consensus. Consensus levels included strong consensus (≥ 95%), consensus (≥ 75%), majority agreement (≥ 50%) and no majority agreement (< 50%). RESULTS: In the prepolling step, 22 participants proposed 26 criteria. In step 1, 23 criteria were selected, of which 6 (23.1%) reached strong consensus, 11 (42.3%) reached consensus, and 6 (23.1%) majority agreement. The remaining 3 (11.5%) criteria proposed were rejected. In step 2, 13 of the 23 criteria (56.5%) were proposed for wording modifications. Of these, four (30.8%) retained initial wording and nine (69.2%) were modified. In step 3, 21 of the 23 criteria were identified as very important (91.3%), while 2 (8.7%) were considered less important. Among the 21 very important criteria, 2 (9.5%) reached strong consensus, i.e., essential, 12 (57.1%) reached consensus, and 7 (33.4%) had majority agreement. Overall, a set of 23 criteria (2 essential, 12 required-1st grade, 7 required-2nd grade, and 2 potential) was recommended to establish HSCC. CONCLUSIONS: This article reveals a consensus among an international group of HCPs and patients on a series of evidence-based criteria for HSCC. Standardized care, a hub and spoke model, multidisciplinary teams, specialized treatments, well-defined protocols, patient education, medical training, and robust referral systems were identified as essential/very important criteria for HSCC.