From the Guidelines
Hidradenitis suppurativa treatment should be based on the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines, with a focus on improving morbidity, mortality, and quality of life. The treatment approach for hidradenitis suppurativa (HS) depends on the severity of the disease, and it typically includes both lifestyle modifications and medical interventions. For mild cases, daily gentle cleansing with antibacterial soap, wearing loose clothing, maintaining a healthy weight, and avoiding smoking are recommended [ 1 ].
Treatment Options
- Topical treatments include clindamycin 1% solution applied twice daily to affected areas [ 1 ].
- For moderate disease, oral antibiotics like tetracycline 500mg twice daily for 4 months or a combination of clindamycin 300mg twice daily with rifampicin 600mg once daily for 10 weeks may be prescribed [ 1 ].
- Severe cases might require biologics such as adalimumab (Humira), injected as 160mg initially, then 80mg two weeks later, followed by 40mg weekly [ 1 ].
- Painful nodules can be treated with intralesional corticosteroid injections.
- Surgery may be necessary for persistent or severe cases, ranging from incision and drainage to wide excision of affected areas.
Diagnosis and Evaluation
The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS [ 1 ]. The treating physician should be familiar with disease severity scores, especially Hurley staging, physician global assessment, and others [ 1 ]. The routine use of patient-reported outcomes, including DLQI, itch, and pain assessment (Visual Analogue Scale), is strongly recommended [ 1 ].
Recent Guidelines
Recent guidelines, such as the North American clinical management guidelines for hidradenitis suppurativa, provide evidence-based recommendations for the diagnosis, evaluation, and treatment of HS [ 1, 1 ]. These guidelines emphasize the importance of a comprehensive treatment approach that includes medical, surgical, and lifestyle modifications to improve patient outcomes.
Conclusion is not needed, and the answer is based on the most recent and highest quality study available, which is [ 1 ] in this case, but more recent studies [ 1, 1 ] support the same approach, with a focus on improving morbidity, mortality, and quality of life.
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.
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 in patients 12 years of age and older 2, 2, and 2.
- The recommended dosage for hidradenitis suppurativa is:
- 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.
From the Research
Hidradenitis Suppurativa Overview
- Hidradenitis suppurativa (HS) is a chronic, recurrent, debilitating disease predominantly involving apocrine gland-bearing skin 3.
- HS is not easily treated and is often misdiagnosed outside specialized clinics and inappropriately treated as a simple boil or abscess 4.
- The disease has a significant impact on quality of life, with one of the highest impacts compared to other dermatologic diseases 5.
Treatment Approaches
- A multifaceted approach is necessary for the treatment of HS, including both medical and surgical interventions 4.
- Medical therapies encompass anti-inflammatory drugs, antimicrobials, and biologics, such as clindamycin, tetracycline, rifampicin, and infliximab 4, 6.
- Surgical treatment is recommended for fibrotic lesions, including minor excision, carbon dioxide-laser, and major surgery 4.
- Adjuvant therapy, including pain management, wound care, and lifestyle modifications, plays a crucial role in the management of HS 4, 6.
Topical Management and Wound Care
- Topical antibiotics, such as clindamycin, and keratolytic agents have been used in the management of early stages of HS 3.
- Proper wound care is essential to the successful management of HS, particularly given the suppurative nature of the disease 3, 5.
- Limited evidence exists regarding the optimal regimen for topical therapy and wound care, highlighting the need for a multidisciplinary approach 3, 5.
Specific Treatments
- Tetracycline, doxycycline, and lymecycline have been shown to be effective in the treatment of HS, with tetracycline providing the greatest clinical improvement measured by Hidradenitis Suppurativa Score (HSS) 7.
- The use of biologics, such as infliximab and adalimumab, has also been explored in the treatment of HS, with promising results 4, 6.