HSF - Treatment of Hidradenitis Suppurativa (HS).

“The goal of medical
therapy in HS is to heal existing lesions and
prevent the development
of new lesions in the
areas potentially
affected by the disease.”
G. Jemec 2004

Treating Hidradenitis Suppurativa is challenging. There is no one treatment that is beneficial for all cases and there is a lack of randomized controlled trials in HS therapy. However, physicians should be able to provide treatment options based on current disease knowledge. Staging the presentation of HS (see below) is beneficial and should be done prior to therapy. It is recommended that treating physicians record standardized outcomes (See Assessment) prior, during and following treatment. Recording this data may also provide sufficient data to assess experimental therapies for HS.

For more information, the HSF provides the following free articles, thanks to the generosity and permission of the publishers and authors:

2004 Medical Treatment of HS by Gregor BE Jemec [1]

2001 Natural History of Hidradenitis Suppurativa by Jan von der Werth et al. [2]

Expert Medical Perspectives
Treatment: The goal of treatment is to reduce the extent and progression of the disease to bring the patient back to a milder stage.

Most of those with HS do not appear to progress to severe disease as indicated in the chart above. Treatment of HS needs to be graduated to reflect disease intensity: Stage I disease is characterized by lesions, flares and sinus tracts that are separated from each other and topical and short-course systemic treatments may be beneficial. In Stage II the flares are linked to each other by tunnels and or by excess, thickened scar tissue. In this stage medical, systemic adjuvant or maintenance therapy, surgery (exteriorization, local excision, laser evaporation) may be beneficial. Stage III disease is characterized by the development of a large area of suppurating (oozing), fibrous tissue. For Stage III HS, wide excision surgery and radiation therapy may be beneficial. For Stage III HS, medical treatment is palliative only. [3]

Experimental Therapies: Often standard therapies fail, and both patient and physician are left with a therapeutic challenge. Most often one of two general approaches is used in off-label/experimental therapy. One avenue of approach is to regard the disease as a predominantly inflammatory disease, and consequently treat with immunosuppressive drugs as in so many other dermatological diseases e.g., systemic therapy. The other avenue of approach is to regard the presence of microbes as the primary pathogenic event and treat heavily with antibiotics. Most available antibiotics have been used to varying effects in individual cases. [3]

Lifestyle Modifications: There is no evidence for common and erroneous social and medical views and judgments that HS results from a lack of hygiene or as a result of socially unacceptable behavior, yet these views that people with HS struggle with often lead them to suffer in silence. This may lead them to conceal the disease even from close family members. While it has not been demonstrated that tobacco smoking or weight gain directly leads to or causes HS, those with HS who are overweight or obese have significantly more serious disease. Coupled with studies that note a higher incidence of smokers in those with HS, it is reasonable for physicians to advocate for weight loss and smoking cessation, hopefully reducing the risk of developing serious co-morbid metabolic disorders such as diabetes and cardiovascular disease. [4]

Acknowledgments & References
[1] Jemec GB. Medical treatment of hidradenitis suppurativa. Expert Opin Pharmacother. 2004; 5(8):1767-1770. Provided online with permission from the author and Informa Healthcare. (This article is subject to copyright and may not be reproduced, distributed or published, in whole or in part, in any form without the permission of the publishers.)