4 Treatment Options for Hidradenitis Suppurativa

What is Treating Hidradenitis?

Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by nodules, abscesses and scars due to inflammation of glands. Common areas affected are the axilla, groin and perianal areas.

This skin condition is not life threatening but its symptoms and complications can be crippling and can affect a person’s self-esteem. Hidradenitis suppurativa may start off as a boil or pimple but can progress to painful abscesses that can break open and heal slowly. Due to the chronic nature of the disease, repeated healing and formation of new abscesses can cause tracts to form that burrow deep into the skin and lead to permanent scars. It is essential to be aware of this so that people affected by it can get treatment for hidradenitis suppurativa.

Treating hidradenitis suppurativa can be difficult. Treatment is not only targeted to treating existing lesions, but also to lessen the recurrence of the lesions and to prevent or slow down the progression of the disease. Various treatment options are available for people seeking help treating hidradenitis suppurativa. This article will discuss the different hidradenitis suppurativa treatments, from conservative management to medical procedures.

Lifestyle Modifications

When treating hidradenitis suppurativa, it is important to make lifestyle changes regardless of the severity of the disease and the treatment started.

• Smoking is associated with an increased occurrence of hidradenitis suppurativa; therefore, quitting smoking is highly encouraged.
• Obesity is also associated with an increased occurrence of hidradenitis suppurativa. Eating a healthy diet and weight loss are encouraged.
• Wearing loose and comfortable clothing can also help, as this can decrease mechanical stress and stretching of the skin which can further cause pain.
• Avoidance of shaving or fragrances can also help as these can be irritants that can worsen symptoms. Shaving not only promotes further mechanical stress, but it can also cause cuts and skin abrasions further promoting infections.

There are also home remedies that can be done in the treatment of hidradenitis suppurativa including:

• Warm compress.
• Salt baths.
• Cleaning the lesions with antibacterial soap and water.

Although these might not treat the condition completely, they can provide temporary relief and alleviation of pain. It is still important to consult a physician to discuss further treatment options, especially with moderate to severe and recurring lesions.

Pharmacologic Therapy: Topical

There are various hidradenitis suppurativa medications available. Most patients with hidradenitis suppurativa benefit from a topical treatment. Patients with acute hidradenitis suppurativa can benefit from topical medications because it can reduce flares and inflammation and treat the infection.

Topical medication is also helpful for mild cases of hidradenitis suppurativa. Guidelines recommend chlorhexidine, benzoyl peroxide and zinc pyrithione antimicrobial washes. Topical antibiotics such as topical clindamycin are given to patients with mild hidradenitis suppurativa.

Triamcinolone administered within the lesions can also be helpful for acute flares and is found to minimize pain and inflammation. Topical retinoids are not recommended and are found to have no use for treating hidradenitis suppurativa.

Pharmacologic Therapy: Systemic

Systemic therapy is recommended for moderate to severe cases of hidradenitis suppurativa, or for mild cases not responsive to topical therapy. Medications that have systemic effects can include antibiotics, hormones, oral retinoids and immunosuppressants. Systemic antibiotics are found to be helpful in treating hidradenitis suppurativa.

The guidelines recommend tetracyclines, combination therapy (clindamycin with rifampin or a combination of moxifloxacin, metronidazole and rifampin), or dapsone as antibiotic options in the treatment for hidradenitis suppurativa. Systemic antibiotics provide enough antimicrobial coverage and treatment of infection. It is important to not self-medicate as antibiotic resistance can occur with improper intake of antibiotics. Consult your doctor so that the best antibiotic therapy can be given to you.

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Hormones have been found to be involved in the occurrence of hidradenitis suppurativa because of the common occurrence after puberty, with some worsening cases during pregnancy or menstrual cycles and studies linking it to polycystic ovary syndrome (PCOS). Because of this, hormonal treatment options have also been considered for treating hidradenitis suppurativa.

In studies, it was found that ethinyl estradiol with norgestrel as well as ethinyl estradiol with cyproterone acetate was helpful. Progestin-only medications are not recommended and some studies found it to further worsen symptoms of hidradenitis suppurativa. Before starting any hormonal treatment, it is best to consult your doctor first.

More studies need to be done for oral retinoids and immunosuppressants as their efficacy in treating hidradenitis suppurativa is limited. However, one medication that was found to be useful for moderate to severe hidradenitis suppurativa is adalimumab. Adalimumab is an immunosuppressant that blocks the effects of tumor necrosis factor (TNF alpha) preventing further inflammation. Among the immunosuppressants, Adalimumab is the most promising and helpful for hidradenitis suppurativa patients.

Surgical Options

If pharmacologic therapy is not helpful, there are various surgical procedures that can be helpful for hidradenitis suppurativa. Because hidradenitis suppurativa is characterized by deep lesions and abscesses, sometimes surgery is indicated for severe lesions. There are various hidradenitis suppurativa surgery options.

1. Draining. New abscesses can be treated by incision and drainage under local anesthesia. This can be done with a blade or punch tool to puncture the skin and allow the pus to seep out. This technique is used for moderate to severe hidradenitis suppurativa. Abscesses that occur in areas where a previous lesion has healed might not benefit as much from incision and drainage but can provide relief of pain. Incision and drainage are also invasive and can result in the loss of a lot of tissue.
2. Deroofing. This is another surgical technique that is fast and promising due to its “tissue-saving” property. In deroofing, only the top or the roof of the abscess or sinus tract is removed. It is fast and minimally invasive and because only the top part is removed, can leave a lot of the surrounding healthy tissues untouched, which is why it is a good option for mild to moderate hidradenitis suppurativa. This procedure can also be helpful for recurrent lesions and lesions with complicated sinus tracts. Despite this, the method can still have bleeding as a complication. It is also not efficient for moderate to severe hidradenitis suppurativa.
3. Laser therapy. Laser therapy has been found to be useful for localized hidradenitis suppurativa as well as mild to moderate hidradenitis suppurativa. It is not as invasive and has faster recovery compared to the previous surgical options. Laser therapy has been found to improve symptoms of hidradenitis suppurativa through the reduction of hair follicles and sweat glands. Currently, laser therapy is only considered an adjunct treatment and is done with systemic therapy.

Because surgery is an invasive procedure, it is important to consult your doctor when discussing hidradenitis suppurativa surgery to determine if surgery can help you and if you are a suitable candidate.

Final Notes

Treatment of hidradenitis suppurativa can be a challenge. There is no single best therapy and treatment is usually tailored to each patient. The important thing for people with the condition is to seek help.

If you or somebody you know is experiencing hidradenitis suppurativa, contact your local physician to discuss treatment options that are suited for you.