From the Guidelines
Treatment options for hidradenitis suppurativa should prioritize a combination of medical and surgical approaches, with a focus on disease severity and patient-specific factors, as recommended by the most recent guidelines 1. The management of hidradenitis suppurativa (HS) involves a multifaceted approach, considering the severity of the disease, patient comorbidities, and lifestyle factors.
Medical Management
For mild cases, topical treatments such as 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, as supported by evidence from the European guidelines for hidradenitis suppurativa 1.
- For more severe or resistant cases, biologics like adalimumab (Humira) at 40mg weekly after initial loading doses have shown effectiveness by targeting TNF-alpha, a key inflammatory mediator, as demonstrated in recent clinical trials 1.
Surgical Management
Surgical options range from incision and drainage (for acute painful lesions) to more definitive wide excision of chronically affected areas.
- Laser hair removal can also reduce recurrence by decreasing hair follicle inflammation, which is central to the disease process.
Lifestyle Modifications and Comorbidity Screening
Lifestyle modifications are essential, including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas.
- Pain management with NSAIDs or acetaminophen helps with discomfort.
- Regular cleansing with antiseptic washes containing chlorhexidine or benzoyl peroxide can help prevent bacterial overgrowth that worsens inflammation.
- Comorbidity screening is crucial, as HS is associated with a higher risk of various comorbidities, including acne, dissecting cellulitis of the scalp, pilonidal disease, and others, as highlighted in recent recommendations from the US and Canadian Hidradenitis Suppurativa Foundations 1. Therefore, a comprehensive treatment plan for hidradenitis suppurativa should include medical management, surgical intervention when necessary, lifestyle modifications, and regular comorbidity screening, with the goal of improving patient outcomes and quality of life, as supported by the most recent and highest quality evidence 1.
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 (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 Weight Recommended 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 greater 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
Treatment Options for Hidradenitis Suppurativa:
- 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 greater. 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
Medical Management
Medical management of HS typically involves the use of antibiotics, such as oral rifampin and clindamycin, or adalimumab to decrease inflammation 4. Additionally, pain management is an essential aspect of HS treatment, and options include:
- Topical analgesics
- Oral NSAIDs, such as celecoxib
- Acetaminophen
- Gabapentin or pregabalin for synergistic effect
- Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine or venlafaxine
Surgical Management
Surgical management of HS may be necessary in some cases, particularly for the destructive phase of the disease 5. Surgery can help to remove damaged tissue and prevent further complications.
Pain Management Modalities
A patient survey found that the most commonly used pain management therapies for HS were warm compresses, ibuprofen/naproxen, Epsom salt baths, cold compresses, and acetaminophen 6. The survey also found that marijuana smoking, marijuana edibles, and opioids received the highest mean effectiveness ratings, while bleach baths, sitz baths, massage, gabapentin, and acetaminophen received the lowest mean effectiveness ratings.
Multidisciplinary Approach
A consensus document recommends a multidisciplinary approach to the management of HS, including diagnosis and assessment, treatment and management, comorbidities, and education 7. The document also suggests that antibacterial and anti-tumour necrosis factor therapies are effective in the treatment of HS, and that further clinical research and the establishment of multidisciplinary management teams will continue to advance management of HS.