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Summary: Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory condition that can have periodic worsening or flares. Measurement of flare is important because it can inform treatment efficacy; however, it is unclear how HS flare should be defined. Objectives: This study reviewed the literature for definitions of HS flare. Methods: The PubMed MEDLINE online database was searched on 10 January 2018 and the search was repeated on 8 December 2018 for new publications. Titles and abstracts were screened for inclusion. Subsequently, full articles were screened for inclusion. Papers were included if the publication was a systematic review, clinical trial, cohort study, case report or series, or cross‐sectional study. Studies were excluded if they were journalistic reviews, did not discuss clinical findings of HS or did not use the words 'flare', 'exacerbation', 'relapse' or 'recurrence'. Results: Two hundred and seventy‐four papers were identified and 154 fulfilled the study criteria. Of these, 27 (17.5%) included the term 'flare' and 16 (10.4%) included the term 'exacerbation'. Two of the 27 papers (7%) defined the term flare and both included patient report of changes in symptoms or signs. One of 16 papers (6%) defined exacerbation, which was taken as one new HS lesion. The terms 'recurrence' and 'relapse' were more apt to be defined: 13% (13 of 100) and 14% (six of 44), respectively. Conclusions : The lack of a specific and measurable definition of HS flare is a barrier to assessment of this important outcome. Once a specific and measurable definition is established, validated and reliable measures of HS flare can be incorporated into future studies. What's already known about this topic? Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory skin condition.The ability to assess flares is important to people who have HS; however, it is unclear how this is defined.HS flare is one of the core outcomes in the core outcome set for HS clinical trials; however, it is unclear how this should be assessed. What does this study add? This literature review reveals the paucity of measurable definitions associated with the use of the term 'flare' in the HS literature.It also highlights the variation and lack of a validated and reliable measure of HS flare. Plain language summary available online Linked Comment: Navrazhina and Frew. Br J Dermatol 2020; 182:7. [ABSTRACT FROM AUTHOR]

Summary: Hidradenitis suppurativa (HS) causes red, painful, draining bumps and tunnels in the skin. About 0.1 to 1% of people have HS in the U.S.A. and Europe. HS is more common in females. HS lesions (affected areas) happen mostly in folds of the body, such as the armpits, under the breast, groin, or buttocks. The lesions can come‐and‐go or last for months or years. HS can have times where it is worse than usual. These have been called 'flares'. To measure flares in future studies, a definition for a flare is needed. This study was done to find out how flares were defined in past studies. The researchers looked in a database of published articles for studies about HS that mentioned the word 'flare' or 'exacerbation'. The researchers found 274 published studies, and 154 of them were good enough to be included in this study. Twenty‐seven studies had the word 'flare' and 16 included the word 'exacerbation.' Only two studies included a definition for the word 'flare' and only one paper had a definition for the word 'exacerbation.' The way to measure a flare (or exacerbation) was by the patient's experience or the clinician's exam of the skin. This review study showed that an HS flare is often not defined in studies, and the definitions are not always the same. A better definition of HS flare needs to be made so that people with HS, clinicians, and researchers can better measure the activity of the HS and the impact of treatments. This summary relates to the study: A narrative review of the definition of 'flare' in hidradenitis suppurativa Linked Article: Kirby et al. Br J Dermatol 2020; 182:24–28 [ABSTRACT FROM AUTHOR]