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ROSEMONT, Ill., Oct. 20, 2026 /PRNewswire/ -- Over 3 million people have been diagnosed with hidradenitis suppurativa (HS) in the United States and today, the American Academy of Dermatology (AAD) and the Hidradenitis Suppurativa Foundation (HSF) have published the first-ever joint guidelines for the management and care of HS. HS is a skin condition that causes painful lumps deep in the skin, typically in areas of the body where skin rubs together like armpits, inner thighs, and the groin. Early diagnosis of HS is critical as it is often confused with acne or infection, causing people to go years without an accurate diagnosis. A board-certified dermatologist can both identify HS and screen for the medical and psychiatric conditions that often accompany it, giving patients access to comprehensive, individualized care sooner. "While hidradenitis suppurativa is a chronic condition, its painful symptoms are highly treatable," said AAD President and board-certified dermatologist Murad Alam, MD, MSCI, MBA, FAAD. "For millions of people with HS, dermatologists provide more than just a diagnosis. They provide expert, comprehensive care that allows patients to have a better quality of life." Compiled by a work group of 13 experts, including 12 board-certified dermatologists, the newly released guidelines, published in the Journal of the American Academy of Dermatology (JAAD), include 37 evidence-based recommendations designed to treat chronic HS disease and acute HS flares. "These guidelines establish an evidence-based standard of care for HS, giving patients, dermatologists, and payers a shared roadmap for what high-quality HS care looks like," said board-certified dermatologist Haley B. Naik, MD, FAAD, co-chair of the Hidradenitis Suppurativa Guideline Work Group and president of HSF. "Every person living with HS deserves care that meets this standard." The largest barrier to impactful HS care is step therapy, an insurance requirement for patients to try insurer-designated treatments before coverage is approved for the dermatologist-prescribed preferred medication. Evidence does not support the use of step therapy in HS care as it delays access to appropriate treatment. Strong recommendations of care Strong recommendations imply that treatment benefits clearly outweigh risks and burdens. These recommendations apply to most patients in most circumstances. Biologics (adalimumab, bimekizumab, infliximab, and secukinumab), injectable treatments that target the immune system, are strongly recommended for individuals with moderate-to-severe HS. These treatments are shown to reduce the number of abscesses and nodules by at least half, without any new abscess or tunnel development. Abscesses are painful lumps that grow, join together, and fill with fluid. Tunnels are hollow channels that form under the skin. Conditional recommendations of care Conditional recommendations imply that treatment benefits are closely balanced with risks and burdens. These recommendations apply to most patients, but the best course depends on what matters most to each individual, including their tolerance for side effects, treatment goals, and day-to-day circumstances. Topical therapies (clindamycin, resorcinol, and ruxolitinib) are applied to the skin to reduce abscesses and the severity of symptoms. Systemic antibiotics (doxycycline, tetracycline, clindamycin in combination with rifampin, and ertapenem) work throughout the body to decrease severity of symptoms and improve quality of life. Hormone therapy (spironolactone) is taken by mouth to decrease severity. Systemic therapies (upadacitinib and short-term systemic steroids) are taken by mouth and work throughout the body for individuals with moderate-to-severe HS to reduce disease activity and pain. Continuing injectable biologics (adalimumab) is recommended for individuals with moderate-to-severe HS undergoing surgery. In-office procedures can be especially helpful if abscesses and tunnels have formed in the skin, including: Deroofing, a minor treatment to open and flatten the tunnels under the skin. This treats recurrent or persistently bothersome HS lesions, or bumps, spots, or growths. Incision and drainage to treat painful abscesses. Surgical removal of an area of affected skin for abscesses or tunnels that persist or continue to come back. Laser hair removal for fewer flares. Botulinum toxin to reduce flares. Intralesional triamcinolone (a steroid injection) to treat painful, flaring bumps. Conditional recommendations were made against the use of oral retinoids (acitretin and isotretinoin), certain biologics (etanercept, guselkumab, risankizumab, and vilobelimab), systemic therapies (avacopan, and methotrexate and azathioprine as primary treatments), and radiotherapy for pediatric and adolescent HS patients. In addition, there is insufficient evidence to support oral contraceptive pills or finasteride (hair loss medication) for HS management. Supportive management While HS therapies may reduce pain, they don't always achieve adequate pain relief. Supportive pain management is a conditional recommendation that helps manage sudden pain, consistent pain, and pain that does not improve after treatment and pain relief therapies. Treatments to manage sudden pain include warm or cool compresses, topical lidocaine (a local anesthetic), acetaminophen (a pain reliever), nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen, steroid injections, incision and drainage, and short-term steroids that work throughout the body. Opioids can be used if the pain doesn't decrease through other treatments. Long-lasting pain can be managed with serotonin norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, psychotherapy, proper wound care, and nerve pain medications such as gabapentin and pregabalin. There is insufficient evidence to support weight reduction and GLP-1 usage for HS treatment. There is also insufficient evidence that specific diet plans — intermittent fasting, the Mediterranean diet, the yeast exclusion diet, and the dairy-free diet — help manage HS. However, a heart-healthy diet of fruits and vegetables, whole grains, healthy fats, and lean proteins remains important for reducing heart and diabetes risk for individuals with HS. Complementary medicine Lifestyle changes and supplements can also help manage the pain and discomfort from HS. A conditional recommendation was made for quitting tobacco, which can improve an individual's response to treatments aimed at addressing the disease itself. Conditional recommendations were made for complementary and alternative medicine, including vitamin D supplements for individuals with deficiencies, and zinc supplements. These supplements, taken under a doctor's supervision, may reduce lumps and tunnels and relieve pain. "Untreated HS can have a serious impact on your health and well-being. It can cause scarring, wounds that limit your mobility, and intense pain. It also often happens in combination with other medical and psychiatric conditions, with this increasing its overall toll on patients," said Dr. Alam. "Whether you've been diagnosed with HS or suspect you may have it, please take the time to see a board-certified dermatologist to have it expertly assessed, consider your options, and find the best plan for you." To find a board-certified dermatologist in your area, visit aad.org/findaderm. Resources Hidradenitis Suppurativa: Overview (AAD) How to Treat HS (HSF) Find an HS Provider (HSF) About the AAD Headquartered in Rosemont, Ill., the American Academy of Dermatology, founded in 1938, is the largest, most influential and most representative of all dermatologic associations. With a membership of more than 21,500 physicians worldwide, the AAD is committed to advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair, and nails; advocating high standards in clinical practice, education and research in dermatology; and supporting and enhancing patient care because skin, hair, and nail conditions can have a serious impact on your health and well-being. For more information, contact the AAD at (888) 462-DERM (3376) or aad.org. Follow @AADskin on Facebook, TikTok, Pinterest, and YouTube, and @AADskin1 on Instagram. About the Hidradenitis Suppurativa Foundation Since its founding in 2005, the Hidradenitis Suppurativa Foundation has fostered and encouraged worldwide research by developing and supporting an interdisciplinary family of scientists and physicians devoted to studying Hidradenitis Suppurativa, in order to deliver more effective forms of treatment and preventative measures to those with this common, debilitating, and eminently chronic disease. HSF is a 501(c)(3) dedicated to improving the lives of people affected by Hidradenitis Suppurativa (HS) through research, education, and advocacy. Explore their resources for patients, clinicians, and investigators at hs-foundation.org, and follow @hsforg on Instagram and YouTube, and @HidradenitisSuppurativaFoundation on Facebook and LinkedIn. SOURCE American Academy of Dermatology 21% more press release views with Request a Demo

点击“蓝字”关注我们 镁离子是维持人体细胞代谢、神经肌肉传导及心肌电生理稳定的重要电解质，机体镁平衡主要依靠肾小管重吸收功能精细调控。肾性失镁是临床易被忽视的病理性低镁血症类型，以肾小管镁重吸收功能障碍为核心病理特征，在正常膳食镁摄入状态下，仍存在持续性肾脏镁离子异常流失。本病可继发于慢性肾间质病变、药物肾损伤等多种肾脏疾病，亦可由相关基因异常导致原发性转运功能缺陷。该病临床表现隐匿、症状缺乏特异性，重度失镁可诱发多系统损害，合并顽固性低钾、低钙血症，甚至严重心律失常与肾钙化病变。本文系统阐述肾性失镁的发病机制、临床特征、诊断标准与规范化分层治疗方案，旨在为临床精准识别、规范诊疗提供参考。 一、病因与发病机制 肾性失镁大多为继发性，如继发于慢性肾脏疾病、肾小管间质疾病和药物肾损害等，原发性较为罕见。 肾小管近端小管对Mg2+的通透性很低，镁离子重吸收的主要区段是在髓袢升支粗段，镁离子重吸收是通过细胞旁路进行的被动转运。其转运需两个必要条件，一是跨管腔膜的电势差。在髓袢升支粗段的腔侧膜上存在Na+-K+-2Cl-共转运体，将钠、钾、氯离子以1:1:2的比例从管腔中主动转运到细胞内，转运至细胞内的钾离子随即通过腔侧膜上的钾通道返回管腔，钠离子被基侧膜上的N+-K+-ATPase泵入管周间隙，氯离子则经基侧膜上的Cl-通道进入管周间隙。由此产生的跨上皮的电势差（管腔内为正）成为Mg2+经细胞旁路重吸收的驱动力。Na+-K+-2Cl-同向转运速率改变决定管腔-管周电势差的变化，从而影响镁离子的重吸收。袢利尿剂如呋塞米通过抑制Na+-K+-2Cl-共转运子妨碍了跨上皮电势差的形成，从而减少了Mg2+的重吸收。因此在使用呋塞米有时会导致尿镁的大量排出[1]。 其次是紧密连接蛋白-16和紧密连接蛋白-19的表达促进细胞旁路镁离子的转运。紧密连接蛋白-16基因突变可诱发表现为以低镁血症，高镁尿症，高钙尿症和肾钙质沉着为特征的疾病。另外，TRPM6基因的突变可以引起严重的低镁血症，其机制可能为减弱肠道对镁离子的吸收及增加肾脏镁离子的丢失。 综上所述，Na+-K+-2Cl-转运体、腔侧膜上的K+通道、基底侧的Cl-通道的转运障碍、紧密连接蛋白-16和紧密连接蛋白-19的表达障碍及TRPM6基因的突变均可以引起镁离子的吸收障碍。 肾脏对Mg2+平衡的调节是通过重吸收的改变来实现的。正常进食吸收的情况下从肾小球滤过的Mg2+绝大部分被肾小管重吸收，由近曲小管、髓袢升支粗段及远曲小管3部分进行重吸收，其中近端小管重吸收镁量约占肾小球滤过镁的25%，髓袢升支粗段约重吸收65%，远曲小管约重吸收5%，从终尿中排除的Mg2+仅5%左右。 镁离子的重吸收过程受到精确的调控，从而保证血清Mg2+水平的稳定，在Mg2+过负荷的情况下，增加的镁负荷不能被肾小管重吸收而完全从终尿中排除。在严重缺镁的情况下，肾脏重吸收显著增强，甚至可以使镁排泄分数（FEMg）小于1%，净排出量小于24mg/d以维持镁离子平衡。 二、临床表现 一般无症状，由实验室检查发现。但在严重情况下Mg2+<0.49mmol/L（1.2mg/dl）出现明显临床症状，包括全身无力，神经肌肉节点的高反应性及反射亢进，手足痉挛，惊厥，震颤及少见的手足搐搦。心电图的表现包括QT间期延长和ST段压低。现将临床表现分述如下[2,3]： （一）神经肌肉症状 缺镁时各种感觉异常、肌痉挛、震颤、手足抽搐、婴幼儿惊厥、佛氏征、陶氏征阳性，肌电图示快速、高峰电位。其他少见症状包括眩晕、眼球震颤、共济失调、扑翼样震颤，舞蹈样运动或昏迷，长期严重缺镁时，甚至出现精神症状，如幻觉、谵妄以至精神分裂等一系列改变。 （二）心血管并发症 低镁血症可抑制心肌细胞膜上的Na+-K+-ATPase活性、增加钾通道的开放，从而减低细胞内钾离子的浓度，导致心肌细胞膜去极化，动作电位阈值降低，同时导致钾离子外流减慢，影响复极过程。因此低镁血症常并发多种心律失常，如房性心动过速、房颤、室性期前收缩、室性心动过速及室颤。心电图特征表现为T波低平、U波明显及QRS波群增宽，这些改变也可能与合并的低钾血症有关。大量研究表明，镁缺乏与高血压之间具有相关性，高血压流行病学研究表明饮食补充镁与血压水平呈负相关。 （三）代谢异常 代谢异常常见为并发低钾血症和低钙血症，据报道，40%的低镁血症患者合并低钾，而12%的患者血钙水平在2.0mmol/L（8mg/dl）以下。由于镁离子是ATP酶的重要辅因子，其缺乏导致Na+-K+-ATPase活性下降，从而导致细胞内失钾，因此在低镁血症存在的同时低钾状态很难纠正，补钾同时需补镁。低血镁性低钙单用钙疗法无效，但单用镁有效；缺镁还导致磷酸尿和细胞内磷酸含量降低。 （四）消化道症状 可出现多种消化道症状，如厌食、恶心、吞咽困难（食管痉挛）、肠道动力降低。另外，镁可抑制尿液晶核形成，缺镁可促发泌尿系结石，偶可致红细胞寿命缩短及贫血。 （五）血小板聚集力增高 糖尿病患者可能有血小板聚集力的增高。 （六）其他 家族性肾性失镁若发病于新生儿期，血浆钙、镁水平极低，特征表现为镁排泄分数<5%的情况下的顽固低镁血症，对钙治疗无反应，镁治疗有效。此病男性多见，男女比例为13:2。在出生6个月内表现为低镁、低钙的神经症状，包括反复的惊厥、谵妄、肌肉痉挛和癫痫发作。婴儿期常表现为多尿、尿钙水平高，早期即出现尿路结石和肾钙化，血浆镁离子浓度低，同时常有多器官系统的累及，特征性的表现为眼部疾病，包括近视、眼球震颤、脉络膜视网膜炎。此外，神经性耳聋、软骨钙化、佝偻病、高血压和痛风性关节炎也有报道。 三、诊断 一般在低镁血症存在的情况下，肾脏重吸收增加，终尿排泄的镁离子均小于12mg/24h；如果在低镁血症的同时24小时尿镁超过24mg，即可诊断为肾性失镁。 四、治疗 肾性失镁的核心治疗原则为去除诱因、分级补镁、纠正合并电解质紊乱、保护肾功能、对症防治并发症，根据患者病情轻重、临床表现及病因差异，制定个体化治疗方案，同时全程监测血镁、肾功能及身体体征，规避补镁过量风险，具体治疗方案如下[4,5]。 轻度无症状肾性失镁患者以保守调理和饮食干预为主，无需药物补镁。此类患者仅实验室检查提示低镁血症，血清镁浓度轻度下降，无明显躯体不适。临床首选高镁饮食调理，日常增加绿叶蔬菜、豆类、坚果、优质动物蛋白、原生态谷物等高镁食物摄入，从源头持续补充人体所需镁元素。同时严格规避肾损伤诱因，停用呋塞米等袢利尿剂、肾毒性药物，积极控制慢性肾病、肾小管间质疾病等原发病，减少肾脏镁离子流失，多数轻症患者可通过长期饮食调理维持血镁稳定，无需药物干预。 中重度有症状患者需开展规范药物补镁治疗，分为口服补镁与静脉补镁两种方式。口服补镁适用于出现神经肌肉轻微症状、生命体征平稳的患者，临床常用硫酸镁、氯化镁、乳酸镁、氧化镁等制剂，常规治疗剂量为18~87mg/(kg·d)，该剂量可有效缓解临床症状、稳定血钙水平。需注意口服镁盐易刺激胃肠道，引发腹胀、腹泻、恶心等不适，临床可根据患者耐受度调整剂量，分次服用减轻肠胃刺激。对于症状显著、血清镁低于0.49mmol/L，伴随手足痉挛、震颤、心律失常的重度患者，需采取静脉补镁，输注过程必须缓慢匀速，严禁快速推注，同时全程监测血镁浓度与膝反射，防止镁蓄积中毒。 针对性对症联合治疗是提升疗效的关键。肾性失镁常合并低钾血症、低钙血症，单纯补钾、补钙疗效极差，需遵循“先补镁、后纠电解质”的原则。镁离子是体内多种ATP酶的核心辅因子，补镁后可恢复细胞膜上Na+-K+-ATPase活性，改善细胞内失钾状态，助力低钾、低钙血症的纠正。同时，针对患者出现的心律失常、神经肌肉痉挛等并发症，在补镁的基础上对症处理，稳定心肌节律、缓解肌肉异常收缩。对于持续性尿镁流失过多的患者，可短期联用螺内酯、阿米洛利，减少肾脏镁离子排泄，辅助提升血镁水平。 针对先天性、难治性肾性失镁患者，需采取特殊治疗方案。由TRPM6基因突变、紧密连接蛋白基因突变引发的原发性肾性失镁，常规补镁仅能缓解症状，无法根治，需长期终身维持补镁治疗，控制病情进展。对于新生儿起病、伴随肾钙化、尿路结石、眼部病变、神经性耳聋的重症患者，在持续补镁的同时，定期监测泌尿系影像学指标，防治结石与肾损伤。若患者进展为终末期肾病，反复严重低镁且药物治疗无效，可评估后行肾移植手术，从根源纠正肾脏镁重吸收功能障碍。 此外，全程病情监测与预后管理不可或缺。治疗期间定期复查血清镁、尿镁、血钙、血钾及肾功能，根据检测结果动态调整补镁剂量。患者康复后需长期规避肾损伤危险因素，坚持健康饮食，定期随访，避免病情复发，最大程度保护肾功能与全身多系统功能。 参考文献 上下滑动可查看 [1] de Baaij JHF. Magnesium reabsorption in the kidney. Am J Physiol Renal Physiol. 2023;324(3):F227-F244.  [2] de Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiol Rev. 2015;95(1):1-46.  [3] Salinas M, López-Garrigós M, Flores E, Leiva-Salinas C. Improving diagnosis and treatment of hypomagnesemia. Clin Chem Lab Med. 2023;62(2):234-248.  [4] Kothari M, Wanjari A, Shaikh SM, et al. A Comprehensive Review on Understanding Magnesium Disorders: Pathophysiology, Clinical Manifestations, and Management Strategies. Cureus. 2024;16(9):e68385.  [5] Tseng MH, Konrad M, Ding JJ, Lin SH. Clinical and genetic approach to renal hypomagnesemia. Biomed J. 2022;45(1):74-87.  声明：本文仅供医疗卫生专业人士了解最新医药资讯参考使用，不代表本平台观点。该等信息不能以任何方式取代专业的医疗指导，也不应被视为诊疗建议，如果该信息被用于资讯以外的目的，本站及作者不承担相关责任。 最新《国际糖尿病》读者专属微信交流群建好了，快快加入吧！扫描左边《国际糖尿病》小助手二维码（微信号：guojitnb），回复“国际糖尿病读者”，ta会尽快拉您入群滴！ （来源：《肾医线》编辑部）