From the Guidelines
Hidradenitis suppurativa treatment should prioritize a holistic evidence-based approach, focusing on lifestyle modifications, topical treatments, and systemic medical management, with adalimumab 40mg weekly being a recommended treatment for severe cases, as supported by the most recent and highest quality study 1.
Overview of Hidradenitis Suppurativa
Hidradenitis suppurativa is a chronic inflammatory skin condition that affects hair follicles in areas where skin rubs together, such as the armpits, groin, buttocks, and under the breasts.
Treatment Approach
Treatment depends on severity but typically begins with lifestyle modifications including:
- Weight loss if overweight
- Smoking cessation
- Wearing loose clothing
- Good hygiene For mild cases, topical treatments like clindamycin 1% solution applied twice daily for 3 months can help. Moderate cases may require oral antibiotics such as doxycycline 100mg twice daily or minocycline 100mg daily for 3-6 months. Severe cases might need anti-inflammatory medications like tumor necrosis factor inhibitors (adalimumab 40mg weekly) or surgical interventions including incision and drainage of painful nodules or excision of severely affected areas. Pain management with NSAIDs or acetaminophen is important.
Key Considerations
- The condition occurs when hair follicles become blocked with keratin, leading to inflammation, bacterial overgrowth, and formation of painful abscesses and sinus tracts.
- The condition is not caused by poor hygiene but is linked to genetics, hormonal factors, and immune system dysfunction.
- Regular follow-up with a dermatologist is essential as this is a chronic condition requiring ongoing management.
- Adalimumab 160 mg at week 0, 80 mg at week 2; then 40 mg subcutaneously weekly is a recommended treatment for severe cases, as supported by the study 1.
Systemic Antibiotics
- Tetracyclines are recommended in mild-to-moderate HS for a 12-week course or as long-term maintenance when appropriate, as stated in the study 2.
- Clindamycin and rifampin in combination is effective as a second-line treatment for mild-to-moderate disease or as a first-line or adjunct treatment in severe disease.
- Moxifloxacin, metronidazole, and rifampin in combination are recommended as second- or third-line treatment in moderate-to-severe disease.
- Dapsone may be effective for a minority of patients with Hurley stage I or II disease as long-term maintenance therapy.
- IV ertapenem is recommended for severe disease as a 1-time rescue therapy or as a bridge to surgery or other long-term maintenance.
Conclusion is not allowed, so the answer just ends here.
From the FDA Drug Label
Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. HUMIRA is used: To treat moderate to severe hidradenitis suppurativa (HS) in people 12 years and older. Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
Adalimumab (HUMIRA) is indicated for the treatment of moderate to severe hidradenitis suppurativa (HS) in patients 12 years of age and older. The recommended dosage for HS is:
- 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:
- 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 [3] [4] 5
From the Research
Hidradenitis Suppurativa Overview
- Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body 6.
- The disease can often result in disfigurement and adversely impact patient quality of life 6.
Diagnosis and Evaluation
- Evaluation and diagnosis of HS disease involves assessment of severity, extent of disease, and impact on patient quality of life 7.
- Initial diagnosis of HS should be shortly followed by comorbidity screening 7.
Treatment Options
- The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities 6.
- A multimodal approach to HS treatment typically involves use of treatment stacking of topical therapies, systemic and topical antibiotics, retinoids, hormonal and metabolic therapies, biologics and small molecule inhibitors, systemic immunosuppressants, surgical treatment, pain management, lifestyle modifications, adjunctive treatment, wound care, and flare therapy 7.
- Clindamycin as a unique antibiotic choice has shown efficacy in HS treatment, with a significant reduction in disease severity parameters and pain 8.
- Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current HS guidelines, with significant efficacy in reducing disease severity and improving quality of life 9.
Inpatient Management
- Patients with moderate to severe HS often seek care in the emergency department and may require hospitalization, with admission offering a unique opportunity to optimize care through specialized consultations, pain management, rescue therapy, and surgical planning 10.
- Multimodal treatments, particularly biologics, are needed to achieve clinical remission in severe disease, and streamlining care during hospitalization can significantly improve flare management and overall clinical outcomes for HS patients 10.