In this article, learn more about the current treatments that are available for hidradenitis suppurativa (HS). This piece will also explore the ongoing research.
HS can be challenging to treat and often requires a multimodal approach.
Making diet and lifestyle changes, such as losing weight and quitting smoking, can help. Doctors frequently use topical antibiotics and antibacterial washes as adjunctive therapy. Many people also require courses of oral antibiotics.
Intralesional steroid injections can be very helpful for painful, draining lesions. In some cases, incision and drainage may be necessary.
In addition, the anti-inflammatory agent adalimumab (Humira) can treat HS. Other biologics have also shown promising efficacy.
There is currently no cure for HS, and no single treatment works in every case.
Although oral antibiotics are currently the first-line treatment, there is a lack of data comparing the efficacy of various regimens.
Doctors usually try oral tetracyclines, oral trimethoprim-sulfamethoxazole, or a combination of oral clindamycin and rifampin first. Anti-inflammatory agents — including adalimumab (Humira), ustekinumab (Stelara), and anakinra (Kineret) — have also produced positive results in many people.
In some cases, surgical therapy can be curative in a particular location.
In general, side effects from HS treatments are mild, particularly compared with the effects of the condition itself.
Adopting a gentle skin care routine will prevent added irritation when using topical antimicrobials and washes. Making lifestyle changes can also be helpful, and wearing loose-fitting clothing can help minimize friction and moisture.
There are many potentially effective treatment options for HS. If topical and oral antibiotics do not work, there are other oral and injectable medications to consider.
Oral spironolactone, a hormone receptor antagonist, and metformin can be effective for women with additional comorbidities. These include obesity, metabolic syndrome, and polycystic ovarian syndrome.
Intralesional steroids can be effective for acutely inflamed lesions. Doctors are increasingly using injectable anti-inflammatory agents that target IL-17, IL12/23, and IL-1 pathways to treat HS.
Finally, surgery can be an effective option for appropriately selected people. Doctors will often recommend surgery in combination with medical therapy and lifestyle changes.
Doctors may consider surgery for individuals with localized disease or those with prominent scarring and sinus tract formation.
Incision and drainage provides immediate relief but no long-term benefit. Wide excision is another surgical procedure that is potentially curative. However, it can take a long time to heal and may lead to pain and scar formation.
Scarring is the result of the ongoing inflammation central to HS. Addressing this inflammation early on and controlling it as best as possible with medical therapy is an effective option to minimize scarring.
People with HS should try to actively seek care before they notice prominent scarring.
Obesity and smoking seem to correlate with disease activity in HS. Therefore, doctors will usually recommend losing weight and quitting smoking.
Also, wearing loose-fitting clothing can help minimize friction.
People with HS often feel self-conscious and are more likely to have mental health comorbidities. For this reason, it is important to receive proper education on the condition, talk to others, and engage in psychosocial support services when necessary.
HS is an active area of ongoing research because there is a need for effective treatment. Researchers are continuing to learn more about the inflammatory pathways responsible in HS pathogenesis.
As well as trying existing targeted therapies, researchers are seeking novel candidates. These agents will likely target the cytokine signaling and gene expression involved in HS pathogenesis.
There are a number of actively enrolling therapeutic clinical trials that will hopefully yield promising new options.
Dr. Sara Perkins is an assistant professor in the Department of Dermatology at the Yale School of Medicine in New Haven, CT. In addition to practicing general medical and surgical dermatology, Dr. Perkins also works as a clinician-educator, training residents and medical students. Dr. Perkins directs the Teledermatology Program within the department and is working to expand this care modality.