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    Hidradenitis Suppurativa therapy options progressing

    Early recognition and treatment can prevent disease progression, improve prognosis

     

    Medical management

    After determining the severity of disease and ruling out or confirming potential comorbidities that can impact the development and progression of HS, Dr. Hazen usually proceeds with therapeutic regimens that target inflammation. These can include a short-course of corticosteroids, intralesional steroids, dapsone, and antibiotics for patients with mild to moderate HS.

    READ: TNF Inhibitors Prove Effective

    Although HS is not an infectious disease, antibiotics are a traditional mainstay of therapy, likely due to their innate anti-inflammatory properties. Interestingly, those antibiotics that appear to have the most effective qualities and work best in quelling the symptoms of HS are agents that have enhanced anti-inflammatory features: tetracyclines, sulfa drugs and erythromycin compounds. Penicillin, cephalosporins, ampicillin and amoxicillin are all generally less effective, Dr. Hazen explains, as these agents have lesser anti-inflammatory features.

    The combination of clindamycin combined with rifampin (an anti-tuberculosis agent with strong anti-inflammatory effects) has been shown to be substantially helpful in controlling the inflammatory process in some patients. 

    Folliculitis Decalvans, Photo credit: Paul Hazen, M.D.

    In more severe HS, or in recalcitrant cases, where initial anti-inflammatory regimens fall short of the therapeutic goal, Dr. Hazen considers using one of the TNF-alfa inhibiting agents such as adalimumab, rituximab, and ustekinumab.

    “Most of the biologics have been used to manage other inflammatory diseases such as psoriasis, psoriatic arthritis, and inflammatory bowl disease. However, sometimes significant improvements can also be achieved with these agents for patients with HS,” Dr. Hazen says.

    READ: Biologics can be antibiotic alternative for hidradenitis suppurativa

    These agents can improve at least the symptoms of the inflammation associated with HS and can be given concomitantly with antibiotics, if needed. Other compounds, such as cyclosporine and even methotrexate, can also be used, although responses are less predictable, Dr. Hazen says.

    Dr. Hazen says that adalimumab is one agent that has undergone extensive clinical trials and has been shown to achieve significant improvement in HS lesions. Anakinra (an IL-1 receptor antagonist) is another novel agent that has shown promise. According to Dr. Hazen, anakinra may improve HS symptoms and may also improve lesions of pyoderma gangrenosum associated with HS.

    NEXT: Comorbidities add to the mix

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