From the Guidelines
Hidradenitis suppurativa treatment should be tailored to disease severity, with a focus on controlling inflammation, preventing new lesions, and managing existing ones to improve quality of life. For mild cases, start with topical clindamycin 1% applied twice daily to affected areas, combined with chlorhexidine or benzoyl peroxide washes, as recommended by the European guidelines for hidradenitis suppurativa 1. Lifestyle modifications are crucial: quit smoking, lose weight if overweight, wear loose clothing, and avoid shaving affected areas.
Treatment Approach
For moderate disease, oral antibiotics like doxycycline 100mg twice daily or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks can be effective, as suggested by the North American clinical management guidelines for hidradenitis suppurativa 1. Hormonal therapy such as spironolactone 50-200mg daily may help women with menstrual flares.
Biologics and Surgery
For severe or refractory cases, biologics like adalimumab (Humira) 40mg weekly after initial loading doses are FDA-approved, with a study showing a significant response rate of 59% versus 28% for placebo 1. Surgical interventions range from incision and drainage for acute painful abscesses to wide excision for chronic disease. Pain management is important throughout treatment.
Key Considerations
It is essential to note that the treatment of hidradenitis suppurativa is challenging, and there is no guarantee that following the guidelines will result in successful treatment, as stated in the publisher's disclaimer 1. The care of a patient with HS is ultimately guided by the physician and patient, with an emphasis on factors unique to individual patients. A holistic evidence-based approach, including the use of disease severity scores and patient-reported outcomes, is strongly recommended to improve treatment outcomes 1.
From the FDA Drug Label
HUMIRA is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
Adults: ◦ Day 1: 160 mg (given in one day or split over two consecutive days) ◦ Day 15: 80 mg ◦ Day 29 and subsequent doses: 40 mg every week or 80 mg every other week
Adolescents 12 years of age and older: Adolescent Weight Recommended Dosage 30 kg (66 lbs) to less than 60 kg (132 lbs) Day 1: 80 mg Day 8 and subsequent doses: 40 mg every other week 60 kg (132 lbs) and greater Day 1: 160 mg (given in one day or split over two consecutive days) Day 15: 80 mg Day 29 and subsequent doses: 40 mg every week or 80 mg every other week
Hidradenitis Suppurativa Treatment: Adalimumab (HUMIRA) is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. The recommended dosage for adults is 160 mg on Day 1,80 mg on Day 15, and 40 mg every week or 80 mg every other week starting on Day 29. For adolescents 12 years of age and older, the dosage is based on weight. 2, 2, 2
From the Research
Treatment Options for Hidradenitis Suppurativa
- Medical therapy: includes anti-inflammatory therapies such as clindamycin, tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab, and anakinra 3
- Surgical therapy: includes minor excision, carbon dioxide-laser, and major surgery, which are used to treat fibrotic lesions 3
- Adjuvant therapy: includes pain management, wound care, and attention, which plays a major role in patients' perception of a successful treatment 3
- Topical therapy: includes topical antibiotics such as clindamycin, and keratolytic agents, which are used in the management of early stages of HS 4
- Biological agents: includes adalimumab, which is the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS 5
- Light therapy: has been used for HS with variable results 5
Comprehensive Approach to Treatment
- A multifaceted approach is necessary as HS lesions include both inflammation and fibrosis 3
- A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended 3
- Treatment strategy should be selected in concordance to disease severity and requires combination of treatments in most cases 5
- Aims of management should include early intervention to prevent irreversible skin damage, adequate control of symptoms including pain, and mitigation of extra-cutaneous comorbidities 6
Current Research and Development
- There is a robust pipeline of immunomodulatory drugs in various stages of development for hidradenitis suppurativa 6
- New therapeutic options are being studied, targeting different specific cytokines involved in HS pathogenesis 5
- Increased research has led to the identification of new potential therapeutic targets 7