What is the treatment for hidradenitis suppurativa?

From the Guidelines

The treatment for hidradenitis suppurativa involves a multi-faceted approach tailored to disease severity, with adalimumab being a recommended biologic for moderate-to-severe cases, as evidenced by the North American clinical management guidelines 1.

Overview of Treatment Approach

The treatment approach for hidradenitis suppurativa (HS) is guided by the severity of the disease and may involve topical treatments, oral antibiotics, biologics, pain management, lifestyle modifications, and surgical interventions.

• For mild cases, topical treatments like clindamycin 1% solution applied twice daily can help control inflammation and infection.
• Moderate cases often require 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 more severe or resistant cases, biologics like adalimumab (Humira) at 40mg weekly may be prescribed, as supported by the guidelines 1.

Biologics in Treatment

The use of biologics, particularly adalimumab, has been recommended for the treatment of moderate-to-severe HS, with studies demonstrating its efficacy in improving disease severity and quality of life 1.

• Adalimumab is currently the only FDA-approved treatment for HS, with a recommended dosing of 160 mg at week 0,80 mg at week 2, and then 40 mg weekly starting at week 4 1.
• Other biologics, such as infliximab, anakinra, and ustekinumab, may also be effective for HS, but require further dose-ranging studies to determine optimal dosing 1.

Additional Considerations

Pain management with NSAIDs or acetaminophen is important, as well as lifestyle modifications, including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas 1.

• Good hygiene practices can help, though the condition is not caused by poor hygiene.
• Warm compresses can provide relief for painful nodules.
• Surgical interventions may be necessary for persistent or severe cases, ranging from incision and drainage of acute abscesses to more extensive excision of chronically affected tissue 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

The treatment for hidradenitis suppurativa is adalimumab (SQ), which is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. The recommended dosage 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 2.

From the Research

Treatment Options for Hidradenitis Suppurativa

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:

• 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

Medications Used in Treatment

Various medications have been used in the treatment of HS, including:

• Tetracycline, doxycycline, and lymecycline, which have been shown to be effective in reducing the severity of HS 4
• Clindamycin and rifampicin, which are often used in combination to treat HS 5
• Adalimumab, which targets TNF and has been approved for the treatment of moderate-to-severe HS 6
• Secukinumab and bimekizumab, which target IL-17 and have been approved for the treatment of moderate-to-severe HS 6
• Isotretinoin, spironolactone, and cyclosporine, which have been used in combination with other medications to treat HS 7

Surgical Treatment

Surgical treatment may be necessary for patients with severe HS or those who do not respond to medical therapy 6. Surgical options include:

• Incision and drainage of abscesses
• Excision of affected tissue
• Skin grafting

Lifestyle Modifications

Lifestyle modifications can also play an important role in the management of HS, including:

• Weight loss, which can help reduce the severity of HS 4
• Avoiding tight clothing and friction, which can irritate the skin and exacerbate HS
• Keeping the affected area clean and dry, which can help prevent infection and promote healing