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    Hidradenitis suppurativa misunderstood and underdiagnosed

     

    Evidence-based treatment 

    Two of the most important steps HS patients can take to successfully treat the disease are to stop smoking and lose weight, according to the experts.

    The current treatment algorithm for HS is in the European guidelines, published online January 30, 2015 in a supplement of the Journal of the European Academy of Dermatology and Venereology.2

    “The European S1 HS guideline suggests that the disease should be treated based on its individual subjective impact and objective severity,” according to the guidelines. “Locally recurring lesions can be treated by classical surgery or laser techniques, whereas medical treatment either as monotherapy or in combination with radical surgery is more appropriate for widely spread lesions. Medical therapy may include antibiotics (clindamycin plus [rifampicin], tetracyclines), acitretin and biologics (adalimumab, infliximab).”

    According to Dr. Prens, dermatologists treating mild HS should consider topical resorcinol 15% cream; topical clindamycin or oral tetracyclines. For moderate disease: topical resorcinol 15% cream; oral tetracyclines, rifampicin/clindamycin oral, acitretin oral; and, in some cases, biologics and surgical de-roofing. Severe disease treatments include: rifampicin/clindamycin oral, acitretin oral; biologic medications adalimumab or infliximab; surgical de-roofing and en bloc resection.

    READ: Early results encouraging in study of adalimumab for hidradenitis suppurativa

    HS treatments that are supported by the data, according to Dr. Jemec, include topical clindamycin 0.1% twice daily; tetracycline 500 mg twice daily; Nd: YAG laser; infliximab; and adalimumab. 

    “Large cohorts further support the use of rifampicin 300 mg BID given with clindamycin 300mg BID, CO2 laser evaporation, de-roofing and surgery,” Dr. Jemec says. “Incision and drainage only works if fluctuating abscesses are found, which is not that common. In general, the patients need a broad approach combining medical and surgical therapy, pain management and appropriate bandages with support for patient self-management.”

    Adalimumab [Humira, AbbVie], the first and only drug to have received FDA approval for the treatment of adults with moderate to severe HS. Adalimumab is the most documented drug for the disease, according to Dr. Jemec.3

    “[Adalimumab] appears to have a clinically significant effect in moderate to severe cases, when given in the same dosage as used for the treatment of Crohn's disease,” Dr. Jemec says. “With the resurgent interest for this often crippling disease, a number of new treatments are being developed in academia, as well as by the industry. I am convinced that over the next ten years our ability to help the many patients more effectively will have improved greatly.”

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.

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