From the Guidelines
Treatment of hidradenitis suppurativa (HS) should be based on the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines, with adalimumab being a key treatment option for moderate to severe disease.
Medical Treatment Options
- For mild disease, topical treatments like clindamycin 1% solution applied twice daily for 12 weeks can help reduce inflammation 1.
- Oral antibiotics such as tetracycline 500mg twice daily for 4 months are effective for mild disease 1.
- For more widespread disease or moderate disease, clindamycin 300mg twice daily with rifampicin 600mg daily for 10 weeks can be considered 1.
- For more severe or resistant cases, biologics like adalimumab (Humira) with an initial dose of 160mg at week 0, 80mg at week 2, and then 40mg subcutaneously weekly can target the underlying inflammation 1.
Surgical Treatment Options
- Surgical options range from incision and drainage for acute abscesses to wide excision of affected areas for recurrent or extensive disease 1.
- Extensive excision can be considered in people with HS to minimize recurrence rate, especially when conventional systemic treatments have failed 1.
Lifestyle Modifications
- Lifestyle modifications are also important, including weight loss if overweight, smoking cessation, wearing loose clothing, and avoiding shaving affected areas.
- Pain management typically involves NSAIDs like ibuprofen 400-800mg three times daily as needed. It is essential to note that individual response to treatment varies and often requires combination therapy, and treatment should be tailored to the specific needs of each patient, taking into account the severity of the disease, the presence of scarring, and the patient's overall health status 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. HUMIRA is used: To treat moderate to severe hidradenitis suppurativa (HS) in people 12 years and older. Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older.
Treatment options for HS include adalimumab (HUMIRA), which is indicated for the treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older 2, 2, 2.
- Key points:
- Adalimumab is used to treat moderate to severe HS.
- It is indicated for patients 12 years of age and older.
- The dosage for HS is as follows:
- 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.
From the Research
Treatment Options for Hidradenitis Suppurativa (HS)
- HS is a chronic inflammatory skin disease that requires a multifaceted approach for treatment, including medical therapy, surgery, and adjuvant therapy 3.
- The recommended anti-inflammatory therapies encompass both antimicrobials and regular anti-inflammatory drugs, such as clindamycin, tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab, and anakinra 3.
- A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and surgery is recommended for the management of HS 3.
- 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.
Medical Therapy
- The combination of oral clindamycin with rifampicin is recommended as a first-line treatment in moderate-to-severe HS 4.
- Oral clindamycin monotherapy may be a useful alternative treatment for HS, with efficacy demonstrated by significant reduction in disease severity parameters 5.
- High body mass index (BMI) and smoking habits seem to be predictive factors of a poor response to antibiotics 4.
Surgical Treatment
- Surgery is the current approach to the management of fibrotic lesions in HS, as manifest fibrosis is generally not susceptible to medical treatment 3.
- Minor excision, carbon dioxide-laser, and major surgery are discussed as treatment options for HS, with current evidence supporting their use 3.
Emerging Therapies
- New therapeutic options are being studied, targeting different specific cytokines involved in HS pathogenesis 6.
- Adalimumab is the only US Food and Drug Administration (FDA) approved biologic agent for moderate-to-severe HS, but other biologic agents and small molecule inhibitors are being investigated 7, 6.
- Treatment strategy should be selected in concordance with disease severity and requires combination of treatments in most cases 7, 6.