From the Guidelines
Treatment for axillary hidradenitis suppurativa involves a combination of approaches based on disease severity, with the most recent and highest quality study recommending adalimumab 160 mg at week 0,80 mg at week 2, and then 40 mg subcutaneously weekly for moderate to severe disease 1.
Overview of Treatment Approaches
The treatment of axillary hidradenitis suppurativa (HS) is multifaceted, targeting the underlying inflammation, bacterial colonization, and follicular occlusion that characterize this chronic, recurrent inflammatory skin condition.
- For mild cases, topical treatments like clindamycin 1% solution applied twice daily or benzoyl peroxide 5-10% wash can help control symptoms.
- Moderate disease often requires oral antibiotics such as doxycycline 100mg twice daily or minocycline 100mg twice daily for 3-6 months.
- For more severe or resistant cases, oral retinoids like acitretin 25-50mg daily or biologics such as adalimumab (Humira) may be necessary, with adalimumab being the only FDA-approved treatment for HS 1.
Lifestyle Modifications and Pain Management
Pain management with NSAIDs or acetaminophen is important, and lifestyle modifications are essential, including:
- Wearing loose-fitting clothing
- Avoiding irritants
- Maintaining good hygiene
- Weight loss if overweight
- Smoking cessation is strongly recommended as smoking worsens the condition.
Surgical Options
Surgical options for persistent or severe cases include:
- Incision and drainage for acute abscesses
- Deroofing procedures
- Wide excision of affected tissue
- Laser hair removal may help prevent recurrence by reducing hair follicles in the affected area.
Guideline Recommendations
The North American clinical management guidelines for hidradenitis suppurativa provide a therapeutic algorithm informed by the evidence available at the time of the review, and recommend a holistic approach to treatment, including medical, surgical, and lifestyle modifications 1. The most recent and highest quality study recommends adalimumab as a first-line biologic treatment for moderate to severe HS 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 axillary hidradenitis suppurativa is adalimumab (SQ). The recommended dosage is:
- For 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.
- For adolescents 12 years of age and older:
- For those weighing 30 kg to less than 60 kg: 80 mg on Day 1, and 40 mg every other week starting on Day 8.
- For those weighing 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 Axillary Hidradenitis Suppurativa
The treatment for axillary hidradenitis suppurativa can vary depending on the severity of the disease. Some of the treatment options include:
- Surgical treatment: This involves the excision of the affected area and coverage with a transposition flap, as reported in 3. The study found that this method had satisfactory functional and aesthetic results, with no flap complications and minimal recurrence.
- Drug therapy: This can include the use of antibiotics, retinoids, hormonal and metabolic therapies, biologics, and small molecule inhibitors, as mentioned in 4 and 5.
- Combination therapy: A combination of systemic clindamycin and rifampicin has been shown to be effective in treating severe hidradenitis suppurativa, as reported in 6.
- Multimodal approach: A comprehensive and updated algorithm for the management of hidradenitis suppurativa involves a multimodal approach, including treatment stacking, lifestyle modifications, and adjunctive treatment, as proposed in 5.
Surgical Treatment
Surgical treatment is often considered the method of choice for axillary hidradenitis suppurativa, as conservative treatment can usually not prevent recurrence, as stated in 3. The study found that radical excision of the affected region and immediate coverage with a flap is the therapy of choice, as it offers a cure and has better functional and aesthetic results compared to open granulation or split skin grafting.
Medical Management
Medical management of hidradenitis suppurativa can include the use of antibiotics, such as clindamycin and rifampicin, as reported in 6. Biologics, such as adalimumab, secukinumab, and bimekizumab, have also been approved for the treatment of moderate-to-severe hidradenitis suppurativa, as mentioned in 4. A multimodal approach, including treatment stacking and lifestyle modifications, can also be effective in managing the disease, as proposed in 5.
Current Research and Guidelines
Current research and guidelines emphasize the importance of early intervention, adequate control of symptoms, and mitigation of extra-cutaneous comorbidities, as stated in 4 and 5. A multidisciplinary approach to the disease is recommended, enabling providers to create the right management plan for each patient, as mentioned in 7.