From the Guidelines
The standard treatment for hidradenitis suppurativa (HS) involves a stepwise approach based on disease severity, with topical treatments, oral antibiotics, and biologics like adalimumab being key components, as recommended by the most recent guidelines 1, 2. The treatment approach for HS should prioritize reducing morbidity, mortality, and improving quality of life.
- For mild cases, topical treatments like clindamycin 1% solution applied twice daily to affected areas can help control symptoms.
- When topical treatments are insufficient, oral antibiotics are typically prescribed, with tetracyclines (doxycycline 100mg twice daily or minocycline 100mg daily) being first-line options for 3-6 months, as supported by evidence from 3.
- For moderate to severe HS, combination therapy with clindamycin 300mg twice daily and rifampin 300mg twice daily for 10-12 weeks has shown effectiveness, as noted in 3.
- In severe or refractory cases, biologics like adalimumab (Humira) are recommended, administered as 160mg initially, followed by 80mg two weeks later, then 40mg weekly thereafter, based on the findings from 2.
- Hormonal therapy with antiandrogens or oral contraceptives may benefit women whose symptoms fluctuate with menstrual cycles.
- Pain management with appropriate analgesics is important throughout treatment.
- Lifestyle modifications including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas can help reduce flares.
- Surgical interventions ranging from incision and drainage for acute abscesses to wide excision of chronically affected tissue may be necessary for some patients, as suggested by 3 and 4. This multifaceted approach targets both the inflammatory and infectious components of HS while addressing contributing factors, ultimately aiming to reduce morbidity, mortality, and improve quality of life for patients with HS.
From the FDA Drug Label
1.8 Hidradenitis Suppurativa HUMIRA is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
The standard treatment for Hidradenitis Suppurativa (Acne Inversa) is adalimumab (HUMIRA) for patients 12 years of age and older with moderate to severe disease 5.
From the Research
Treatment Overview
The standard treatment for Hidradenitis Suppurativa (Acne Inversa) involves a multimodal approach, including:
- Lifestyle modifications, such as wearing loose-fitting clothes, losing weight if overweight, and smoking cessation 6
- Topical medications, such as clindamycin, for mild disease 6, 7
- Systemic antibiotics, such as tetracyclines, for moderate disease 6
- Immunomodulators, such as adalimumab, for moderate to severe disease 6, 8, 9
- Surgical interventions, such as local procedures or wide excision, for severe or extensive disease 6, 8, 10, 9
Treatment by Disease Severity
Treatment plans are tailored to the disease severity and burden of each patient, with:
- Mild disease: topical clindamycin alone can be effective 6
- Moderate disease: oral antibiotics, such as tetracyclines, in addition to topical clindamycin 6
- Moderate to severe disease: adalimumab, a tumor necrosis factor alpha inhibitor, can be effective 6, 8
- Severe or extensive disease: surgical procedures, such as wide excision, may be necessary 6, 8, 10, 9
Multidisciplinary Approach
A multidisciplinary approach is necessary to address all aspects of Hidradenitis Suppurativa, including: