Management of Hidradenitis Suppurativa
June 2002
in “
Clinical and experimental dermatology
”
hidradenitis suppurativa hair follicle inflammation tetracyclines macrolides topical clindamycin oral clindamycin hormonal therapy steroids intra-lesional steroids immunosuppressants cyclosporin isotretinoin acitretin surgical intervention radical excision simple incision and drainage sinus tracks HS antibiotics clindamycin steroids immunosuppressants cyclosporine Accutane surgery
TLDR Effective treatment for hidradenitis suppurativa varies, with antibiotics commonly used and surgery as an option, but no single method is universally successful.
Hidradenitis suppurativa (HS) is a chronic skin condition characterized by recurrent deep abscesses, sinus tract formation, and scarring, primarily affecting areas with apocrine glands. Diagnosis can be challenging due to the lack of specific tests and features. The disease is thought to originate from hair follicle inflammation rather than apocrine glands. Treatment options are largely empirical, with anti-acne antibiotics like tetracyclines or macrolides commonly used, and topical clindamycin being the only treatment supported by a randomized controlled trial (RCT). Severe cases may require oral clindamycin, and targeted antibiotics if specific pathogens are identified. Hormonal therapy has shown effectiveness in one RCT, but safety concerns limit its use. Steroids may offer temporary relief but often lead to relapse, while intra-lesional steroids can be beneficial for localized disease. Immunosuppressants like cyclosporin have shown some promise, and while isotretinoin is not effective, acitretin may be more beneficial. Surgical intervention has varying success rates, with radical excision showing a 25% recurrence rate at 20 months, compared to a 100% recurrence rate with simple incision and drainage. Opening sinus tracks is considered a good compromise by many.
