In Reply We are grateful for the very constructive and positive feedback from Kokolakis and Sabat regarding our newly proposed Severity Assessment of Hidradenitis Suppurativa (SAHS) score.1
We would like to add 3 short additional comments. First, we completely agree that a clear differentiation between inflammatory nodule and especially initial abscess formation is often impossible. It is somehow astonishing that this differentiation has been maintained over years in different scoring systems and that there is even a fundamental difference in weighting the 2 lesions, with abscess formation giving 2 points vs 1 point for inflammatory nodules (eg, Sartorius Score). In our opinion this seems at least questionable, since in daily clinical practice we are mostly not confronted with typical solitary abscesses with extensive fluctuation that always necessitate surgical treatment. Inflammatory nodules as well as initial abscess formation can both respond to anti-inflammatory treatment modalities. Hence, in our center, the differentiation between inflammatory lesions other than fistula, meaning both inflammatory nodules and abscesses, is separated from fistulas, which do present irreversible tissue damage with subsequent necessity for surgical intervention.
Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG. Distinguishing Mild, Moderate, and Severe Hidradenitis Suppurativa—Reply. JAMA Dermatol. 2018;154(8):972. doi:10.1001/jamadermatol.2018.1600
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