From the Guidelines
The treatment for hidradenitis suppurativa typically involves a combination of approaches tailored to disease severity, with the most recent guidelines suggesting a therapeutic algorithm informed by available evidence 1. When considering treatment options, it's essential to prioritize morbidity, mortality, and quality of life as outcomes.
Treatment Approaches
- For mild cases, topical treatments like clindamycin 1% solution applied twice daily to affected areas can help control inflammation and infection.
- For moderate to severe disease, oral antibiotics are often prescribed, including tetracyclines (doxycycline 100mg twice daily for 3 months) or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks, as recommended by recent guidelines 1.
- Anti-inflammatory medications such as intralesional corticosteroid injections can reduce acute flares.
- For severe or resistant cases, biologics like adalimumab (Humira), given as 160mg initially, then 80mg two weeks later, followed by 40mg weekly, may be necessary.
- Hormonal therapy with antiandrogens or retinoids like acitretin can also be beneficial for some patients.
- Pain management is important and may include NSAIDs or other analgesics.
- Lifestyle modifications are crucial, including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas.
- Surgical interventions ranging from incision and drainage of acute abscesses to wide excision of chronically affected tissue may be needed for severe cases, as suggested by the European guidelines for hidradenitis suppurativa 1. These treatments work by targeting the underlying pathophysiology of hidradenitis suppurativa, which involves follicular occlusion, inflammation, and secondary bacterial infection in apocrine gland-bearing skin.
Key Considerations
- The most recent guidelines provide a comprehensive approach to managing hidradenitis suppurativa, including a therapeutic algorithm 1.
- A combination of medical and surgical approaches is often necessary for optimal outcomes.
- Patient education and lifestyle modifications are essential for managing the disease and improving quality of life.
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
The treatment for hidradenitis suppurativa is adalimumab (SQ), with the following dosing regimen:
- Adults: 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:
- 30 kg to less than 60 kg: 80 mg on Day 1, and 40 mg every other week starting on Day 8.
- 60 kg and greater: 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 2.
From the Research
Treatment Options for Hidradenitis Suppurativa
The treatment for hidradenitis suppurativa (HS) can be challenging and often requires a multimodal approach. Some of the treatment options include:
- 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
- Flare therapy 3
Medications Used in Treatment
Some medications that have shown promising results in the treatment of HS include:
- Clindamycin and rifampin combination therapy 4, 5
- Isotretinoin/spironolactone for mild disease 4
- Isotretinoin or doxycycline with adalimumab for moderate disease 4
- Cyclosporine/adalimumab for severe disease 4
- Adalimumab, which targets TNF 6
- Secukinumab and bimekizumab, which target IL-17 6
Surgical Interventions
Surgical interventions, such as tissue-sparing surgical techniques and carbon dioxide laser treatments, may also be used to treat HS, especially in cases where medical therapy is not effective 5
Comprehensive Management Algorithm
A comprehensive management algorithm for HS involves evaluation and diagnosis of the disease, assessment of severity and extent of disease, and impact on patient quality of life, followed by a multimodal approach to treatment, including treatment stacking of various therapies 3
Importance of Early Intervention
Early intervention is crucial in preventing irreversible skin damage and mitigating extra-cutaneous comorbidities, and requires an interdisciplinary, holistic, and personalized approach 6