Treatments of Hidradenitis suppurativa

There are several different treatment options for hidradenitis suppurativa, including lifestyle changes, pharmaceuticals and surgical procedures.

The aim of treatment is typically to clear or reduce breakouts, prevent the formation of new lesions, and eradicate the scars and sinus tracts. Many patients will trial several different treatment methods before finding the best management plan for their condition and symptoms.

Lifestyle

Hidradenitis suppurativa is a chronic condition for the lifetime of an individual, but certain lifestyle changes can be beneficial to reduce or prevent breakouts. Changes that may prove to beneficial include:

• Weight loss
• Stopping smoking
• Eating a nutritious diet
• Wearing loose-fitting clothing
• Use of antibacterial or antiseptic soap on affected area
• Avoid shaving affected area
• Avoid perfumes and deodorants on affected area
• Avoid intense heat and sweating

If sinus tracts develop, the area will need to be dressed similarly to a wound.

Pharmaceutical Options

There are several different medication options for the treatment of hidradenitis suppurativa, as outlined below.

Acne washes with benzoyl peroxide are typically available over the counter and can be useful to reduce the symptoms of hidradenitis suppurativa. However, most patients will require other treatments in addition to this.

Bleach baths can be beneficial to eradicate certain bacteria that colonise on the skin. This can be done in the patient’s home and is effective to manage specific species of bacteria.

A short course of antibiotics is often required to reduce inflammation and eradicate bacterial infections when a new breakout appears. A long-term course can also be used to prevent worsening of symptoms.

Hormonal therapy with the oral contraceptive pill can be effective to relieve the symptoms of hidradenitis suppurativa. Spironolactone may also offer a benefit as a result of its action to regulate certain hormones in the body, reducing pain and the volume of fluid in the breakouts.

Retinoid medications (e.g. acitretin) that are high in vitamin A can help to stop the secretion of sebum, which can prevent pore blockage and new breakouts from forming.

Metformin can sometimes be useful in the treatment of metabolic syndrome for patients that suffer from hidradenitis suppurativa.

Corticosteroid medications (e.g. prednisolone) can be injected intravenously to relieve the pain and swelling of a cyst during a breakout. Oral adminstrations can be used over the long term to reduce inflammation and prevent new breakouts. However, there are several side effects associated with the chronic use of corticosteroids, such as weight gain and osteoporosis, which should be considered before making a treatment decision.

Biologic medications (e.g. adalimumab or infliximab) can be used to reduce the number of abscesses in patients with a severe form of the disease, classified as Hurley stage II or III. This class of drug is administered via injection and has an effect on the immune response of the body. There are some severe adverse effects associated with the use adalimumab and the benefits and risks of the treatment should be considered before initiating therapy.

In severe cases, methotrexate can be used to help control symptoms, due to its effect on the immune system. This is a cytotoxic medication used in higher doses to treat cancer, but can still lead to significant adverse effects when used in lower doses in the management of hidradenitis suppurativa.

Radiation Therapy

Radiation therapy involves the controlled exposure of radiation to the affected area, which may help to manage breakouts. However, the efficacy of this is unclear and it is used less often in current practice.

Surgery

For severe cases of hidradenitis suppurativa when other treatments are not effective, surgery may be needed to address the condition. There are several different procedures that may be carried out, depending on the situation, including:

• Laser surgery: concentrated beams of light directed towards the affected area destroy the hair follicles and are relatively effective at clearing breakouts.
• Cytotherapy: liquid nitrogen is used to freeze lesions
• Deroofing: deep, painful hidradenitis suppurativa is transformed into scar tissue for recurrent episodes.
• Drainage: facilitating the release of fluid from the lesions for short-term relief.
• Incision: removal of the lesions for short-term relief as they may return.
• Excision: removal of the lesions and surrounding skin followed by a new skin graft for a lasting effect, although nearby areas may be affected.

References

• https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa
• http://patient.info/health/hidradenitis-suppurativa-leaflet
• http://dermnetnz.org/acne/hidradenitis-suppurativa.html
• http://www.nhs.uk/conditions/hidradenitis-suppurativa/Pages/Introduction.aspx
• http://emedicine.medscape.com/article/1073117-treatment#showall