What are the treatment options for Hidradenitis suppurativa (Acne inversa)?

From the Guidelines

Hidradenitis suppurativa (Acne inversa) treatment options include medical therapy, surgical interventions, and adjuvant therapy.

Medical Therapy

• For mild disease, treatment consists of topical Clindamycin 1% solution/gel b.i.d. for 12 weeks or Tetracycline 500 p.o. b.i.d. for 4 months 1
• For more widespread disease or moderate-to-severe disease, Clindamycin 300 p.o. b.i.d. with Rifampicin 600 p.o. o.d. for 10 weeks can be considered 1
• If patient is not improved, Adalimumab 160 mg at week 0,80 mg at week 2; then 40 mg subcutaneously weekly can be administered 1

Surgical Interventions

• Surgical interventions are relatively underrepresented in the management pathway because evidence of high quality, in the form of randomized controlled trials, is sparse 1
• Extensive excision can be considered for patients with severe disease, and healing by secondary intention, TDAP flap or other method can be used 1

Adjuvant Therapy

• Pain management, weight loss, tobacco cessation, treatment of super infections, and application of appropriate dressings should be offered as needed 1
• Patient-reported outcomes including DLQI, itch and pain assessment (Visual Analogue Scale) should be used to assess disease severity and response to treatment 1

From the Research

Treatment Options for Hidradenitis Suppurativa

The treatment options for Hidradenitis suppurativa (Acne inversa) can be categorized into medical and surgical therapies.

• Medical treatments include:
  • Antibiotics 2, 3, 4
  • Retinoids 2
  • Antiandrogens 2
  • Immunomodulatory drugs such as adalimumab, secukinumab, and bimekizumab 2, 5, 3
  • Anti-inflammatory agents 2
  • Radiotherapy for early lesions 2
• Surgical treatments include:
  • Simple excision 2, 3, 4
  • Complete local excision followed by skin graft 2
  • Wide excision for more extensive disease 3
  • Intralesional or systemic steroids may also be considered 3

Combination Therapies

Combination therapies, such as antibiotics and hyperbaric oxygen therapy, have shown promising results but need further confirmation 2.

Recommendations

The most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy, based on the quality of evidence 2. However, the evidence on most of these treatments is deficient, and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management 2, 5, 6, 3.

Treatment Approach

Treatment should be individualized according to the site and extent of the disease, and absolute cessation of smoking is essential in the treatment of hidradenitis suppurativa 4. Aims of management should include early intervention to prevent irreversible skin damage, adequate control of symptoms including pain, and mitigation of extra-cutaneous comorbidities, all requiring early diagnosis and an interdisciplinary, holistic, and personalized approach 5.