What are the supportive treatments for Hidradenitis (hidradenitis suppurativa)?

From the Guidelines

Supportive treatments for Hidradenitis Suppurativa (HS) include a multidisciplinary team approach, patient education, and management of symptoms such as pain and infection.

Key Supportive Treatments

• Pain management: treat pain if needed 1
• Dressings for pus-producing lesions: provide dressings for pus-producing lesions 1
• Screening for comorbidities: screen people with HS for associated comorbidities including depression, anxiety and cardiovascular risk factors 1
• Smoking cessation: refer people with HS to smoking-cessation services 1
• Weight management: refer people with HS to weight-management services 1

Medical Interventions

• Oral tetracyclines: offer oral tetracyclines such as doxycycline or lymecycline for at least 12 weeks to people with HS 1
• Combination treatment with oral clindamycin and rifampicin: offer combination treatment with oral clindamycin 300 mg twice daily and rifampicin 300 mg twice daily for 10–12 weeks to people with HS who are unresponsive to oral tetracyclines 1
• Adalimumab: offer adalimumab 40 mg weekly to people with moderate-to-severe HS that is unresponsive to conventional systemic therapy 1
• Intralesional corticosteroid injections: consider intralesional corticosteroid injections for carefully selected, individual HS lesions during the acute phase 1
• Clindamycin 1% solution: consider clindamycin 1% solution in people with HS 1

Surgical Interventions

• Surgical intervention: assess the need for surgical intervention in all patients depending upon type and extent of scarring, and implement an evidence-based surgical approach 1

From the Research

Supportive Treatments for Hidradenitis Suppurativa

The following treatments are supported by evidence for the management of hidradenitis suppurativa:

• Topical therapies 2
• Systemic antibiotics 2
• Hormonal therapies 2
• Immunomodulating medications, including anti-TNF-α and anti-IL-17 agents 3, 2, 4, 5
• Biologics, such as adalimumab and secukinumab, which have shown moderate efficacy in treating HS 4, 5
• Surgical procedures, including drainage and excision of affected areas 2, 6, 5

Medical Management

Medical management of hidradenitis suppurativa may involve:

• Antibacterial therapies to reduce bacterial load and prevent infection 3
• Anti-inflammatory therapies to reduce inflammation and prevent scarring 3, 2
• Immunomodulating therapies to target specific pathways involved in the pathogenesis of HS 4, 5

Surgical Management

Surgical management of hidradenitis suppurativa may involve:

• Incision and drainage of abscesses and infected areas 2, 6
• Excision of affected skin and tissue to prevent further inflammation and scarring 2, 6, 5
• Reconstruction of affected areas to improve appearance and function 6