From the Guidelines
The best treatment for hidradenitis suppurativa involves a multifaceted approach tailored to disease severity, with adalimumab being the only FDA-approved treatment, administered as 160mg initially, followed by 80mg two weeks later, then 40mg weekly, as supported by the most recent and highest quality study 1.
Treatment Approach
The treatment of hidradenitis suppurativa (HS) should be based on the severity of the disease. For mild cases, topical treatments such as clindamycin 1% applied twice daily for 3 months can help control symptoms 1.
Moderate to Severe Disease
For moderate to severe disease, oral antibiotics like doxycycline 100mg twice daily or a combination of clindamycin 300mg twice daily with rifampin 300mg twice daily for 10-12 weeks are effective 1.
Biologics
Severe cases may require biologics such as adalimumab (Humira), which has shown significant efficacy in reducing symptoms and improving quality of life 1.
Lifestyle Modifications
Lifestyle modifications are crucial, including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas 1.
Surgical Options
Surgical options, including incision and drainage for acute abscesses or excision for chronic disease, may be necessary for some patients 1.
Quality of Life
The treatment of HS should also focus on improving quality of life, with patient-reported outcomes such as DLQI and pain assessment (Visual Analogue Scale) being important measures of treatment effectiveness 1.
Benefit-Risk Ratio
A benefit-risk ratio structured assessment is needed to evaluate treatments, both short and long term, to ensure that the benefits of treatment outweigh the risks 1.
Conclusion is not allowed, so the answer will be ended here.
From the FDA Drug Label
Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. Hidradenitis Suppurativa (2. 6): Adults:◦ Day 1: 160 mg (given in one day or split over two consecutive days)◦ Day 15: 80 mg ◦ Day 29 and subsequent doses: 40 mg every week or 80 mg every other week
The best treatment for hidradenitis suppurativa (HS) according to the label is adalimumab (HUMIRA), with a specific dosing regimen:
- Adults: 160 mg on Day 1,80 mg on Day 15, and 40 mg every week or 80 mg every other week starting on Day 29.
- Adolescents 12 years of age and older:
- 30 kg to less than 60 kg: 80 mg on Day 1, and 40 mg every other week starting on Day 8.
- 60 kg and greater: 160 mg on Day 1,80 mg on Day 15, and 40 mg every week or 80 mg every other week starting on Day 29 2.
From the Research
Treatment Options for Hidradenitis Suppurativa (HS)
The treatment of HS is individualized according to the site and extent of the disease 3. Initially, short-term antibiotics, local care, and incision and drainage are helpful.
- Unroofing of sinus tracks, total disease excision, and vigorous physical therapy are more beneficial 3.
- Primary or secondary closure or closure by an advancement flap or selective split-thickness skin grafting should be considered in some refractory cases 3.
- Biologic therapies, such as adalimumab, infliximab, and etanercept, have been tested in the treatment of HS but vary in effectiveness and in how well they have been studied 4.
- Subcutaneous weekly adalimumab is the only biologic agent approved by the US Food and Drug Administration (FDA) and the European Medicine Agency (EMA) for the treatment of HS 4, 5.
- Treatment options for HS include topical clindamycin, triamcinolone acetonide, clobetasol, topical resorcinol, oral antibiotics, hormonal therapy, oral retinoids, and biologic therapies 4.
- A multi-tiered treatment approach, including antibacterial, antihormonal, anti-inflammatory, and surgical options, is important for intellectually and developmentally disabled patients with HS 6.
Medical Treatment
Medical treatment for HS includes:
- Topical antibiotics, such as clindamycin 4
- Oral antibiotics, such as doxycycline or minocycline 4
- Hormonal therapy, such as spironolactone or finasteride 4, 6
- Oral retinoids, such as isotretinoin 4, 6
- Biologic therapies, such as adalimumab or infliximab 4, 5, 6
Surgical Treatment
Surgical treatment for HS includes: