From the Guidelines
For a hidradenitis suppurativa (HS) exacerbation, I recommend starting with adalimumab 160 mg at week 0,80 mg at week 2, and then 40 mg subcutaneously weekly, as it has shown to be effective in reducing symptoms and improving quality of life 1. This approach is based on the most recent and highest quality study available, which demonstrated the efficacy of adalimumab in achieving a clinical response in patients with moderate to severe HS. Some key points to consider in the management of HS exacerbation include:
- Using warm compresses applied to affected areas 3-4 times daily for 10-15 minutes to help reduce pain and promote drainage
- Implementing pain management with over-the-counter analgesics like acetaminophen or ibuprofen
- Applying topical clindamycin 1% solution twice daily to control bacterial growth
- Using oral antibiotics, such as doxycycline or clindamycin, for moderate to severe flares
- Keeping the area clean with gentle antiseptic washes and avoiding tight clothing, shaving, and antibacterial soap
- Considering surgical intervention, such as incision and drainage, if symptoms worsen It's essential to note that long-term management of HS often requires maintenance therapy with medications like spironolactone, oral retinoids, or biologics to prevent recurrences, as suggested by the European guidelines for hidradenitis suppurativa 1. Additionally, patient-reported outcomes, such as DLQI, itch, and pain assessment, should be routinely used to monitor the effectiveness of treatment and adjust the therapeutic approach as needed 1. Overall, a multi-faceted approach that incorporates medical and surgical interventions, as well as lifestyle modifications, is crucial in managing HS exacerbations and improving patient outcomes.
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 FDA drug label does not answer the question of how to manage Hidradenitis Suppurativa (HS) exacerbation. It only provides information on the treatment of moderate to severe HS.
From the Research
Hidradenitis Suppurativa (HS) Exacerbation
- HS is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body 2
- The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities 2
- A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended for the management of HS 3
Treatment Options
- The recommended anti-inflammatory therapies encompass both antimicrobials and regular anti-inflammatory drugs, including clindamycin, tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab, and anakinra 3
- Clindamycin as a unique antibiotic choice has shown efficacy in reducing HS severity scores and pain 4
- Non-biologic and non-interventional modalities, such as topical analgesics and oral NSAIDs, can be used to treat HS-related pain 5
Pain Management
- First-line HS pain treatments include topical analgesics and oral NSAIDs, such as celecoxib and acetaminophen 5
- If these are inadequate, gabapentin or pregabalin can be added for synergistic effect, and an SNRI such as duloxetine can be added if necessary 5
- Adjuvant therapy, including pain management, wound care, and attention, plays a major role in patients' perception of a successful treatment and is of practical importance to their coping and self-management 3