From the Guidelines
The treatment of hidradenitis suppurativa involves a multifaceted approach 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.
Treatment Options
The treatment approach for hidradenitis suppurativa (HS) should be based on the evaluation of the inflammatory components as well as the scarring, and should be directed by evidence-based guidelines 2.
- For mild cases, topical clindamycin 1% solution/gel applied twice daily for 12 weeks or tetracycline 500 mg orally twice daily for 4 months can help control inflammation 2.
- Moderate disease often requires 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 severe or refractory cases, biologics like adalimumab (Humira) are effective by targeting TNF-alpha, with a recommended dose of 160 mg at week 0, 80 mg at week 2, and then 40 mg subcutaneously weekly 1.
Lifestyle Modifications and Surgical Interventions
Lifestyle modifications are crucial, including:
- Weight loss if overweight
- Smoking cessation
- Wearing loose clothing
- Avoiding shaving affected areas Pain management with NSAIDs or acetaminophen is important, and surgical interventions ranging from incision and drainage for acute abscesses to wide excision for chronic disease may be necessary 2, 3.
Disease Severity and Quality of Life
The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS, and the treating physician should be familiar with disease severity scores, especially Hurley staging and Physician Global Assessment 2, 3.
- Patient-reported outcomes, including DLQI and pain assessment (Visual Analogue Scale), are extremely important and should be used to measure the efficacy of treatment 2, 3.
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 option for hidradenitis suppurativa (HS) is adalimumab (SQ), with the following dosing regimens:
- 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 4.
From the Research
Treatment Options for Hidradenitis Suppurativa (HS)
The treatment options for HS can be categorized into medical and surgical approaches.
Medical Treatment:
- Topical treatments: clindamycin, dapsone, and resorcinol 5, 6, 7
- Oral antibiotics: tetracyclines, fluoroquinolones, and metronidazole 5, 7
- Hormonal therapy: oral contraceptive pills, spironolactone, finasteride, and dutasteride 5
- Biologic therapies: adalimumab, infliximab, and etanercept 5, 6, 8, 9
- Other treatments: zinc, acitretin, oral prednisone, and cyclosporine 5
Surgical Treatment:
Lifestyle Modifications
Lifestyle modifications, such as weight loss, wearing loose-fitting clothes, and smoking cessation, are also recommended for patients with HS 5, 7
Disease Severity Assessment
Assessment of disease severity is essential for the development of evidence-based treatments. Several scoring systems are available, including Hurley staging, HS Physician's Global Assessment (PGA), the modified Sartorius score (MSS), and the HS Severity Index (HSSI) 6