From the Guidelines
The management of hidradenitis suppurativa involves a combination of medical and surgical approaches, including topical therapies, systemic antibiotics, hormonal therapies, and immunomodulating medications.
Medical Management
- For mild disease, topical Clindamycin 1% solution/gel twice daily for 12 weeks or Tetracycline 500 mg orally twice daily for 4 months can be used 1.
- For more widespread disease or moderate-to-severe disease, Clindamycin 300 mg orally twice daily with Rifampicin 600 mg orally once daily for 10 weeks can be considered 1.
- If there is no improvement, Adalimumab 160 mg at week 0,80 mg at week 2, and then 40 mg subcutaneously weekly can be administered 1.
Surgical Management
- Surgical intervention should be assessed in all patients depending on the type and extent of scarring, and an evidence-based surgical approach should be implemented 1.
- For extensive disease, referral to a multidisciplinary team for surgical management, including excision and reconstruction, may be necessary 1.
Additional Considerations
- Pain management, weight loss, tobacco cessation, treatment of superinfections, and application of appropriate dressings should be offered as adjuvant therapy as needed 1.
- Disease severity scores, such as Hurley staging, and patient-reported outcomes, including DLQI and pain assessment, should be used to guide management 1.
From the Research
Management of Hidradenitis Suppurativa
The management of hidradenitis suppurativa (HS) involves a comprehensive approach that includes medical and surgical treatments. The goals of management are to prevent irreversible skin damage, control symptoms, and mitigate extra-cutaneous comorbidities 2.
Medical Treatment
Medical treatment options for HS include:
- Antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents, and radiotherapy for early lesions 3
- Adalimumab, an anti-tumor necrosis factor antibody, which has been shown to be effective in reducing Sartorius score and pain 3
- Combination therapies, such as antibiotics and hyperbaric oxygen therapy, which have shown promising results but require further confirmation 3
Surgical Treatment
Surgical treatment options for HS include:
- Simple excision or complete local excision followed by skin graft, which is often the first choice for intractable disease presenting in the late stages 3
- Other surgical procedures, such as incision and drainage, debridement, and skin grafting, which may be necessary for advanced disease 4
Multidisciplinary Approach
A multidisciplinary approach to HS management is recommended, involving collaboration between primary healthcare providers, dermatologists, and other medical specialists 5, 6. This approach can help to improve the quality of care for HS patients and address associated comorbidities.
Treatment Guidelines
Practical guidelines for managing HS patients have been developed, which provide a framework for diagnosis and management, including the use of electronic medical record templates to increase collaboration between healthcare providers 6. These guidelines aim to improve the quality of care for HS patients and address the significant variability in response to therapy within the HS patient population.
Current and Future Treatments
Current treatment options for HS are often complex and require an individual approach, with medical and surgical treatments available 4. There is an urgent need for new treatment approaches, particularly for moderate-to-severe HS, and increased research has led to the identification of new potential therapeutic targets 4. A robust pipeline of immunomodulatory drugs is in various stages of development for HS, which may expand treatment options in the future 2.