From the Guidelines
Prophylactic treatment for hidradenitis suppurativa (HS) should prioritize a holistic approach, incorporating lifestyle modifications, topical and systemic medical management, and consideration of biologics for moderate to severe cases, as recommended by the most recent guidelines 1. The goal of prophylactic treatment is to prevent flares and disease progression, thereby improving quality of life and reducing morbidity and mortality associated with HS. Key components of prophylactic treatment include:
- Daily cleansing with antiseptic washes containing chlorhexidine or benzoyl peroxide to reduce bacterial load on the skin
- Topical clindamycin 1% applied twice daily to affected areas to prevent bacterial colonization
- Systemic prevention with tetracycline antibiotics like doxycycline 100mg once or twice daily for 3-6 months
- Hormonal therapy with combined oral contraceptives or spironolactone 50-200mg daily for women whose flares correlate with menstrual cycles
- Lifestyle modifications, such as avoiding tight clothing, maintaining a healthy weight, quitting smoking, and avoiding shaving affected areas
- Consideration of laser hair removal for hair-bearing regions prone to HS
- Regular use of zinc supplements (15mg elemental zinc daily) to help reduce inflammation For moderate to severe cases, biologics like adalimumab (Humira) 40mg weekly after initial loading doses provide long-term prophylaxis, as supported by recent guidelines 1. It is essential to note that managing HS in special patient populations, such as those with pregnancy, breastfeeding, pediatrics, malignancy, tuberculosis infection, hepatitis B or C infection, and HIV disease, requires a multidisciplinary approach and consideration of unique needs, as highlighted in recent guidelines 1.
From the FDA Drug Label
HUMIRA is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
The recommended subcutaneous dosage of HUMIRA for adult patients with hidradenitis suppurativa is 160 mg initially on Day 1 (given in one day or split over two consecutive days), followed by 80 mg two weeks later (Day 15). Two weeks later (Day 29) begin a dosage of 40 mg every week or 80 mg every other week.
For adolescents 12 years of age and older, the recommended dosage is:
- 30 kg (66 lbs) to less than 60 kg (132 lbs): Day 1: 80 mg, Day 8 and subsequent doses: 40 mg every other week
- 60 kg (132 lbs) and greater: 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
Prophylactic treatment for hidradenitis suppurativa: The FDA drug label for adalimumab (HUMIRA) indicates that it is approved for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. However, it does not provide information on prophylactic treatment for hidradenitis suppurativa.
- Key points:
- HUMIRA is approved for the treatment of moderate to severe hidradenitis suppurativa.
- The recommended dosage for adult patients is 160 mg initially, followed by 80 mg two weeks later, and then 40 mg every week or 80 mg every other week.
- For adolescents 12 years of age and older, the recommended dosage varies based on weight.
- Clinical decision: Based on the available information, adalimumab (HUMIRA) can be used for the treatment of moderate to severe hidradenitis suppurativa, but its use as a prophylactic treatment is not supported by the FDA drug label 2, 2, 2.
From the Research
Hidradenitis Suppurativa Prophylactic Treatment
There are various treatment options available for hidradenitis suppurativa (HS), including medical and surgical approaches. The goal of treatment is to reduce inflammation, prevent future lesions, and improve quality of life.
Medical Treatment Options
- Antibiotics such as clindamycin, tetracycline, and doxycycline have been shown to be effective in reducing inflammation and preventing future lesions 3, 4
- Anti-inflammatory medications such as triamcinolone and infliximab may also be used to reduce inflammation 3
- A study published in 2021 found that oral treatment with tetracycline, doxycycline, and lymecycline was effective and safe in HS patients, with tetracycline providing the greatest clinical improvement 4
Surgical Treatment Options
- Surgery may be necessary to remove fibrotic lesions and prevent future lesions 3, 5
- Minor excision, carbon dioxide-laser, and major surgery are all options for surgical treatment 3
- A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended for the management of HS 3
Adjuvant Therapy
- 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
- Adjuvant therapy should be used in conjunction with medical and surgical treatment to provide comprehensive care for HS patients 3