From the Guidelines
Hidradenitis suppurativa treatment should be approached with a multi-faceted strategy, prioritizing topical and systemic medical management, as well as lifestyle modifications, to minimize morbidity, mortality, and improve quality of life.
Treatment Options
- For mild cases, topical clindamycin 1% solution applied twice daily to affected areas for 3 months, combined with chlorhexidine or benzoyl peroxide washes, is a recommended initial treatment 1.
- For moderate disease, oral antibiotics like doxycycline 100mg twice daily or minocycline 100mg twice daily for 3-6 months are effective 1.
- Severe or refractory cases may require biologics such as adalimumab (Humira), administered as 160mg initially, then 80mg two weeks later, followed by 40mg weekly, as it has shown significant improvement in HiSCR responses compared to placebo 1.
Lifestyle Modifications
- Weight loss if overweight
- Smoking cessation
- Wearing loose clothing
- Avoiding shaving affected areas
- Pain management with NSAIDs or other analgesics should be addressed
Surgical Interventions
- Incision and drainage for acute abscesses
- Deroofing procedures for tunnels
- Wide excision for extensive disease may be necessary, and the need for surgical intervention should be assessed in all patients depending upon type and extent of scarring 1. Adalimumab is currently the only FDA-approved treatment for HS, and its use should be considered in severe or refractory cases, with a treatment regimen of 160mg initially, then 80mg two weeks later, followed by 40mg weekly 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 option for Hidradenitis Suppurativa (HS) is adalimumab (HUMIRA). 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 Hidradenitis Suppurativa
The treatment of hidradenitis suppurativa (HS) includes a range of options, from topical and oral medications to biologic therapies and surgical procedures.
- Topical treatments:
- Oral medications:
- Biologic therapies:
- Surgical procedures:
Disease Severity Assessment
Disease severity assessment is essential for the development of evidence-based treatments. Several scoring systems are available, including:
- Hurley staging 3, 7, 5
- HS Physician's Global Assessment (PGA) 3
- Modified Sartorius score (MSS) 3
- HS Severity Index (HSSI) 3
- International Hidradenitis Suppurativa Severity Score System (IHS4) 7
Combination Therapies
Combination therapies may be effective for patients with HS, particularly those with moderate to severe disease. Examples of combination therapies include: