What is the treatment for a hidradenitis suppurativa (HS) flare?

From the Guidelines

Treating a hidradenitis suppurativa flare requires a multi-faceted approach, with the most effective treatment being Adalimumab 160 mg at week 0,80 mg at week 2; then 40 mg subcutaneously weekly, as recommended by the North American clinical management guidelines for hidradenitis suppurativa 1. For immediate relief, warm compresses applied to affected areas for 10-15 minutes several times daily can help reduce pain and promote drainage. Over-the-counter pain relievers like ibuprofen (400-800mg every 6-8 hours) or acetaminophen (500-1000mg every 6 hours) can manage discomfort. Topical antibiotics such as clindamycin 1% solution applied twice daily may help prevent secondary infection. For more severe flares, oral antibiotics are often prescribed, typically doxycycline 100mg twice daily or clindamycin 300mg three times daily for 7-10 days. Intralesional corticosteroid injections (triamcinolone 5-10mg/mL) administered by a healthcare provider can rapidly reduce inflammation in individual lesions. During flares, wear loose-fitting clothing, avoid shaving affected areas, and use gentle, antibacterial cleansers. Avoid squeezing or lancing boils yourself as this can worsen inflammation and spread infection. Some key points to consider when treating hidradenitis suppurativa include:

• The use of adjuvant therapy as needed, such as pain management, weight loss, tobacco cessation, treatment of superinfections, and application of appropriate dressings, as recommended by the European guidelines for hidradenitis suppurativa 1.
• The importance of assessing the need for surgical intervention in all patients, depending on the type and extent of scarring, and implementing an evidence-based surgical approach, as recommended by the British Association of Dermatologists guidelines for the management of hidradenitis suppurativa 1.
• The use of a therapeutic algorithm informed by the evidence available, as provided in the North American clinical management guidelines for hidradenitis suppurativa 1.
• The consideration of complementary and procedural management strategies, such as the use of complementary therapies and procedural treatments, as recommended by the North American clinical management guidelines for hidradenitis suppurativa 1. The most recent and highest quality study recommends Adalimumab as the first line treatment for hidradenitis suppurativa, with a significant improvement in HiSCR response at 12 weeks compared to placebo 1.

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.

2.6 Hidradenitis Suppurativa (HS): 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

Hidradenitis Suppurativa Flare Treatment: The recommended dosage of adalimumab for adults with hidradenitis suppurativa is 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. For adolescents 12 years of age and older, the dosage is based on weight:

• 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.

Key Points:

• Adalimumab is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
• The dosage regimen for hidradenitis suppurativa includes an initial dose, a dose on Day 15, and subsequent doses based on weight for adolescents or a standard dose for adults.
• It is essential to follow the recommended dosage and administration instructions for adalimumab to ensure effective treatment of hidradenitis suppurativa flares.

From the Research

Hidradenitis Flare Treatment

• Hidradenitis suppurativa (HS) is a chronic and debilitating skin disease that requires a multifaceted approach for treatment, including anti-inflammatory therapies and surgery 3.
• The recommended anti-inflammatory therapies encompass both antimicrobials and regular anti-inflammatory drugs, such as clindamycin, tetracycline, and triamcinolone 3.
• A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended for the management of HS, with adjuvant therapy playing a major role in patients' perception of a successful treatment 3.
• Evidence suggests that antibacterial and anti-tumour necrosis factor therapies are effective in the treatment of HS, as supported by clinical experience and expert opinions 4.

Treatment Options for HS Flares

• Systemic antibiotics, nonprescription pain relievers, intralesional triamcinolone injections, prescription pain relievers, oral corticosteroids, and warm compresses are commonly used therapies for HS flares by experts 5.
• Lifestyle changes, such as preventative interventions, can help manage symptoms and reduce the frequency of recurrence 6.
• The importance of adjuvant therapy, including pain management, wound care, and attention, is stressed in the management of HS 3.

Definition and Measurement of HS Flares

• There is a lack of a specific and measurable definition of HS flare, which is a barrier to assessment of this important outcome 7.
• A literature review reveals the paucity of measurable definitions associated with the use of the term 'flare' in the HS literature, highlighting the need for a validated and reliable measure of HS flare 7.