From the Guidelines
Treatment options for Hidradenitis suppurativa (HS) should be individualized based on disease severity, affected areas, and patient preferences, with the goal of reducing inflammation, preventing new lesions, and improving quality of life, as recommended by the most recent guidelines 1.
Overview of Treatment Options
Treatment for HS can include both medical and surgical approaches. Medical management may involve:
- Topical treatments like clindamycin 1% solution applied twice daily for mild cases
- Oral antibiotics such as doxycycline 100mg twice daily or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks for moderate to severe cases
- Biologics like adalimumab (Humira) at 40mg weekly after initial loading doses for more severe or resistant cases
- Hormonal therapy with spironolactone 100-200mg daily for women with menstrual flares
- Pain management with NSAIDs like ibuprofen 400-600mg every 6 hours as needed
Lifestyle Modifications and Surgical Options
Lifestyle modifications are essential and include:
- Weight loss if overweight
- Smoking cessation
- Wearing loose clothing
- Avoiding shaving affected areas Surgical options range from:
- Incision and drainage for acute abscesses
- Wide excision of chronically affected tissue for severe disease
- Laser hair removal to reduce recurrence by eliminating hair follicles, which are often the initial site of inflammation in HS
Special Considerations
The most recent guidelines also provide recommendations for special patient populations, including pregnancy, breastfeeding, pediatrics, malignancy, tuberculosis infection, hepatitis B or C infection, and HIV disease 1.
Key Recommendations
- The treatment approach should be holistic, considering both medical and surgical options, as well as lifestyle modifications 1.
- Adalimumab is recommended for moderate to severe HS that does not respond to other treatments 1.
- Surgical intervention should be considered for patients with severe disease or significant scarring 1.
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 Options for Hidradenitis Suppurativa (HS):
- 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 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 (HS)
The treatment of Hidradenitis Suppurativa (HS) can be challenging and often requires a multimodal approach with the use of on- and off-label medications 3. The following are some of the treatment options available for HS:
- Topical therapies
- Systemic and topical antibiotics
- Retinoids, such as isotretinoin, acitretin, and alitretinoin 4
- Hormonal and metabolic therapies
- Biologics, such as adalimumab, secukinumab, and bimekizumab 5
- Small molecule inhibitors
- Systemic immunosuppressants
- Surgical treatment
- Pain management
- Lifestyle modifications
- Adjunctive treatment
- Wound care
- Flare therapy
Role of Antibiotics and Systemic Therapies
Antibiotics and conventional systemic therapies continue to be the indispensable first-line treatments for HS 6. These therapies remain important for treating mild-to-moderate HS and serve as adjunct or bridge treatments in severe cases.
Importance of Early Intervention
Early intervention is crucial to prevent irreversible skin damage, adequate control of symptoms including pain, and mitigation of extra-cutaneous comorbidities 5. Aims of management should include early diagnosis and an interdisciplinary, holistic, and personalized approach.
Available Treatment Guidelines
There are existing treatment guidelines for HS, including the 2019 North American HS (NAHS) clinical management guidelines 3. These guidelines provide a comprehensive approach to the management of HS, including evaluation and diagnosis, comorbidity screening, and treatment options.
Need for Further Research
More research is needed to evaluate the comparative effectiveness of topical and systemic treatments and to better understand the pathogenesis, natural history, and subtypes of hidradenitis suppurativa 7.