From the Guidelines
Adalimumab at the approved HS dosing is recommended to improve disease severity and quality of life in patients with moderate-to-severe HS. This recommendation is based on the most recent and highest quality study available, which suggests that adalimumab is effective in improving disease severity and quality of life in patients with moderate-to-severe hidradenitis suppurativa (HS) 1.
Treatment Approach
The treatment approach for HS typically involves a combination of medical and surgical interventions, depending on the severity of the disease. For mild cases, topical antibiotics like clindamycin 1% solution applied twice daily can help control inflammation and infection. For moderate disease, oral antibiotics such as doxycycline 100mg twice daily for 3 months, or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks, may be prescribed 1.
Biologics and Lifestyle Modifications
For more severe cases, biologics like adalimumab (Humira) 40mg weekly injections may be necessary 1. Pain management with NSAIDs like ibuprofen 400-600mg every 6 hours can help with discomfort. Lifestyle modifications are crucial, including weight loss if overweight, smoking cessation, and avoiding tight clothing that causes friction. Surgical options include incision and drainage for acute painful abscesses, deroofing procedures for recurrent lesions, or wide excision for extensive disease.
Disease Severity and Quality of Life
The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS, and disease severity should be measured using the Hurley staging system or other validated instruments 1. Patient-reported outcomes, including pain and quality of life, should be regularly assessed using tools like the DLQI or Skindex. The Hidradenitis Suppurativa Clinical Response (HiSCR) is a useful endpoint for clinical trials, defined as a 50% reduction from baseline in inflammatory nodules and abscesses, with no increase in abscesses or draining sinuses 1.
Key Considerations
Key considerations in the management of HS include:
- Regular follow-up to monitor disease severity and adjust treatment as needed
- A holistic approach that incorporates medical, surgical, and lifestyle modifications
- Patient education and support to improve adherence to treatment and quality of life
- Ongoing research to develop new and effective treatments for this chronic and debilitating condition.
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. Hidradenitis Suppurativa (2. 6): 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 WeightRecommended 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 greaterDay 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
Treatment for Hidradenitis Suppurativa: Adalimumab (SQ) is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
- Adults: The recommended dosage 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.
- Adolescents 12 years of age and older: The recommended dosage is based on weight, with 80 mg on Day 1 and 40 mg every other week for those weighing 30 kg to less than 60 kg, and 160 mg on Day 1,80 mg on Day 15, and 40 mg every week or 80 mg every other week for those weighing 60 kg or more 2.
From the Research
Treatment Options for Hidradenitis Suppurativa
- A multifaceted approach is necessary for the treatment of hidradenitis suppurativa (HS), including anti-inflammatory therapies, antimicrobials, and surgery 3.
- The recommended anti-inflammatory therapies encompass both antimicrobials and regular anti-inflammatory drugs, such as clindamycin, tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab, and anakinra 3.
- A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended for the management of HS 3.
Medical Therapies
- Topical therapies, systemic and topical antibiotics, retinoids, hormonal and metabolic therapies, biologics and small molecule inhibitors, and systemic immunosuppressants are commonly used in the treatment of HS 4.
- The combination of oral clindamycin with rifampicin is recommended as a first-line treatment in moderate-to-severe HS 5.
- Oral clindamycin in monotherapy may be a useful alternative treatment for HS 5.
Surgical Therapies
- Surgery is the current approach to the management of fibrotic lesions in HS, as manifest fibrosis is generally not susceptible to medical treatment 3.
- Minor excision, carbon dioxide-laser, and major surgery are discussed as treatment options for HS, with current evidence supporting their use 3.
Adjuvant Therapies
- Adjuvant therapy, including pain management, wound care, and attention, plays a major role in patients' perception of a successful treatment and is of practical importance to their coping and self-management 3.
- Lifestyle modifications, adjunctive treatment, and flare therapy are also important components of HS management 4.
Emerging Therapies
- New and emerging therapies that specifically target cytokines involved in HS pathogenesis are being investigated, including anticytokine therapies 6.
- The potential therapeutic roles of anticytokine therapies, including both the expanded application of existing molecules as well as the specific development of novel therapies for HS, are being discussed 6.