From the Guidelines
Hidradenitis suppurativa treatment should be tailored to disease severity, with a multifaceted approach that includes topical treatments, oral antibiotics, biologics, and lifestyle modifications, as recommended by the most recent guidelines 1.
Treatment Options
- For mild cases, topical treatments like clindamycin 1% solution applied twice daily to affected areas can help control inflammation and infection, as supported by the European guidelines for hidradenitis suppurativa 1.
- Daily antiseptic washes with chlorhexidine or benzoyl peroxide can reduce bacterial load on the skin.
- For moderate disease, oral antibiotics are often needed, with first-line options including doxycycline 100mg twice daily or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks, as recommended by the North American clinical management guidelines for hidradenitis suppurativa 1.
- For severe or refractory cases, biologics like adalimumab (Humira) at 40mg weekly after initial loading doses have shown effectiveness by targeting TNF-alpha, a key inflammatory mediator, as supported by the British Association of Dermatologists guidelines for the management of hidradenitis suppurativa 1.
Lifestyle Modifications and Surgical Interventions
- Lifestyle modifications are crucial, including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas.
- Surgical interventions ranging from incision and drainage for acute painful abscesses to wide excision for chronic disease may be necessary, as recommended by the European guidelines for hidradenitis suppurativa 1.
- Pain management should not be overlooked, using appropriate analgesics based on pain severity.
Disease Severity Assessment
- The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS, using consensus diagnostic criteria that require typical lesions in typical sites and chronic and recurrent disease, as recommended by the British Association of Dermatologists guidelines for the management of hidradenitis suppurativa 1.
- Baseline disease severity should be measured using the Hurley staging system, and patient-reported outcomes such as pain and quality of life should be assessed using validated instruments like the DLQI, as recommended by the British Association of Dermatologists guidelines for the management of hidradenitis suppurativa 1.
From the FDA Drug Label
HUMIRA is a tumor necrosis factor (TNF) blocker indicated for: ... Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
HUMIRA is used: ... moderate to severe hidradenitis suppurativa (HS) in people 12 years and older.
The treatment option for Hidradenitis Suppurativa (HS) is adalimumab (HUMIRA), a TNF blocker, for moderate to severe HS in patients 12 years of age and older 2, 2, 2.
From the Research
Treatment Options for Hidradenitis Suppurativa (HS)
The treatment options for HS depend on the morphology, extent, severity, and duration of the disease.
- For mild HS, topical clindamycin and dapsone are often adequate 3.
- For Stage 1 and 2 HS, first-line treatment combines rifampin with either oral clindamycin or minocycline 3.
- Other HS treatments include:
- Fluoroquinolones with metronidazole and rifampin
- Oral dapsone
- Zinc
- Acitretin
- Hormone blockers (oral contraceptive pills, spironolactone, finasteride, and dutasteride)
- Oral prednisone 3
- For severe HS, cyclosporine, adalimumab, or infliximab (used at double psoriatic doses) and intravenous carbapenems or cephalosporins are often required 3.
- Isotretinoin, etanercept, isoniazid, lymecycline, sulfasalazine, methotrexate, metformin, colchicine, clarithromycin, IVIG, and thalidomide are less favored treatments 3.
- The role of botulinum toxin is uncertain 3.
- De-roofing fluctuant nodules and injection of intralesional corticosteroids can ameliorate the disease and perhaps improve HS more permanently if done at regular intervals 3.
- Surgical excision and CO2 laser ablation are more definitive treatments 3.
- The 1064 nm laser for hair removal can aid in the treatment of HS 3.
- LAight® therapy, a combination of intense pulsed light and radiofrequency, can significantly enhance treatment efficacy when used as an adjunct to first-line therapies in Hurley stage I and II HS 4.
- Current treatment includes drug therapy, combined drug and surgical therapy, or surgery alone, depending on the phase of the disease 5.
- Systemic antibiotics, such as clindamycin, are commonly used in the treatment of HS due to their anti-inflammatory properties and antimicrobial effects 6.
- Emerging treatments, including biologic agents targeting TNF and IL-17, are being developed and show promise in the management of moderate-to-severe HS 5, 7.