Hidradenitis Suppurativa - Treatments

Treatments

Treatments may vary depending upon presentation and severity of the disease. Due to the poorly studied nature of this disease, the effectiveness of the drugs and therapies listed below is unclear, and patients should discuss all options with their physician or dermatologist. Nearly a quarter of patients state that nothing relieves their symptoms. Possible treatments include:

• Lifestyle
  • Changes in diet avoiding inflammatory foods, foods high in refined carbohydrates.
  • Warm compresses with distilled vinegar water, and taking hot baths with distilled white vinegar in the water hydrotherapy, balneotherapy.
  • Icing the inflamed area daily until pain reduction is noticed.
  • Weight loss in overweight and obese patients, as well as smoking cessation can improve or even alleviate many symptoms of hidradenitis suppurativa. Obese and overweight patients should be encouraged to lose weight and assisted in their weight loss efforts regardless of the HS stage in which the patient currently resides.

• Medication
  • Antibiotics- taken orally, these are used for their anti-inflammatory properties rather than to treat infection. Most effective is a combination of rifampicin and clindamycin given concurrently for 2–3 months. This brings about remission in around three quarters of cases. A few popular antibiotics used to treat HS include tetracycline, minocycline, and clindamycin.
  • Corticosteroid injections. Also known as intralesional steroids: can be particularly useful for localized disease, if the drug can be prevented from escaping via the sinuses.
  • Vitamin A supplementation
  • Anti-androgen therapy: hormonal therapy with cyproterone acetate and ethinyl estradiol proved effective in randomized, controlled trials. Dosages reported have been very high.
  • IV or subcutaneous infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade), etanercept (Enbrel), and adalimumab. This use of these drugs is not currently Food and Drug Administration (FDA) approved and is somewhat controversial, and therefore may not be covered by insurance.
  • Zinc gluconate taken orally has been shown to induce remission. Recommended dose is at least 30 mg taken 3 times daily (90 mg/day). Toxicity is known to occur at doses exceeding 1000 mg/day.
  • Chlorhexidine (Hibiclens) plus an antibiotic soap for cleansing the skin surface. Hexachlorophene shower with liquid soap like Phisohex, covering sores with Metrolotion after medicated showers. These are considered to be general measures, and are the foundation of any good medical treatment and management plans for HS.
  • Turmeric capsules orally or through topical application. The active ingredient in the turmeric spice is curcumin.
  • Infliximab: a chimeric monoclonal anti-TNF antibody has demonstrated efficacy in treating HS.
  • Topical clindamycin has been shown to have an effect in double-blind placebo controlled studies.
  • Topical resorcinol is a keratolytic agent that targets the follicular keratin plug and has been shown to have efficacy in several case series studies.

• Radiation

Electron beam radiotherapy has been a successful treatment of hidradenitis, especially in Europe; it is not a common treatment option in most of the United States, as radiation oncologists generally refuse to treat patients with non-malignant diseases because of the potential for secondary radiation-induced tumors in the long term.

• Surgical therapy

When the process becomes chronic, wide surgical excision is the procedure of choice. Wounds in the affected area do not heal by secondary intention, and immediate application of a split thickness skin graft is more appropriate.