What topical medicine helps facilitate drainage of hidradenitis suppurativa (HS) lesions?

Topical Treatments for Hidradenitis Suppurativa Drainage

For facilitating drainage of hidradenitis suppurativa lesions, resorcinol 15% cream is the most effective topical treatment, reducing pain and duration of abscesses when applied twice daily during flares and daily between flares. 1

First-Line Topical Options

• Resorcinol 15% cream acts as a keratolytic and antiseptic agent that helps reduce pain and duration of abscesses in Hurley stage I or II disease, though it may cause irritant dermatitis in some patients 1
• Topical clindamycin 1% solution/gel twice daily for 12 weeks can reduce pustules but has limited effect on inflammatory nodules and abscesses 1, 2
• Antiseptic washes including chlorhexidine, benzoyl peroxide, and zinc pyrithione are supported by expert opinion for cleansing affected areas 1, 2

Intralesional Treatments

• Intralesional triamcinolone (10 mg/mL, 0.2-2.0 mL) injected directly into inflamed HS lesions demonstrates significant reductions in erythema, edema, suppuration, and size 1, 2
• Pain reduction with intralesional steroids can be observed as early as 1 day after injection 1
• This approach is recommended for short-term control of HS flares based on evidence showing significant improvement in physician-assessed parameters 1

Treatment Algorithm Based on Disease Severity

For Mild Disease (Hurley Stage I):

1. Start with topical resorcinol 15% cream twice daily during flares and daily between flares 1
2. Add topical clindamycin 1% solution twice daily for 12 weeks if needed 1, 2
3. Consider antiseptic washes with chlorhexidine, benzoyl peroxide, or zinc pyrithione 1

For Moderate to Severe Disease (Hurley Stage II-III):

1. Continue topical treatments as adjunctive therapy 1
2. Add intralesional triamcinolone for acute inflamed lesions 1
3. Consider systemic therapies such as tetracyclines, clindamycin-rifampin combination, or biologics for more extensive disease 1, 2

Important Considerations and Pitfalls

• Topical clindamycin carries a high risk of bacterial resistance development, which may be mitigated by combining with benzoyl peroxide 1
• Resorcinol can cause irritant dermatitis, so patients should be monitored for skin reactions 1, 3
• Topical treatments alone are rarely sufficient for moderate to severe disease and should be combined with systemic therapies for optimal outcomes 1, 4
• For acute lesions across all disease stages, warm compresses can be used alongside topical treatments to help facilitate drainage 1

Evidence Limitations

• The evidence for topical therapies in HS is limited, with few randomized controlled trials 5, 4
• Most recommendations for topical treatments are based on small studies or expert opinion 1, 3
• The oldest study supporting topical clindamycin dates back to 1983, showing significant improvement compared to placebo but primarily for pustules rather than nodules or abscesses 6

While topical treatments can help manage mild disease and provide symptomatic relief, they typically need to be combined with other therapeutic approaches for optimal management of moderate to severe hidradenitis suppurativa 1, 4.