TREATMENT OPTIONS

A topical treatment is a medication that is applied to one place, typically on the surface of the body. Many topical treatments are epicutaneous which means they are applied directly to the skin. These can come in many different forms but most often as lotions/creams/ointments.

Depending on the product, these treatments can work to cleans an infected area, ease irritation or aid in healing.

Some common topical treatments for HS include:

• Chlorhexidine Zinc
• Pyrithione
• Resorcinol Cream 15%
• Topical Antibiotics
• Retinoids
• Corticosteroids.

While these treatments do not treat the underlying cause of the condition they can aid in easing some of the symptoms.

Oral antibiotics are generally prescribed to help fight infection but with HS they often serve the dual purpose of helping to manage inflammation. 

This type of treatment is typically used for moderate to severe HS when topical treatments have been deemed ineffective. Though they can also be prescribed for mild disease.

Oral antibiotics used to treat HS can include:

• Tetracycline antibiotics
• Clindamycin
• Metronidazole (flagyl)
• Moxifloxacin (avelox)
• Rifampicin (Rimactane)
• Dapsone

The length of which these medications should be taken will be determined by your physician. Some will be taken as little as 7-10 days. However, longer courses of antibiotics lasting several months isn’t uncommon.

HS is thought to be affected by hormones.The most common  being Androgens which are produced by both males and females, but typically at a lower rate in females. Hormonal changes like the menstrual cycle may increase the severity of HS symptoms in women. Pregnancy on the other hand may cause some patients to go into remission, while it may cause others to flare.

Some hormonal treatments have been found effective for the treatment of HS. These types of medications can include: 

• Hormonal contraceptives (oral, subcutaneous, etc)
• Spironolactone
• Finasteride
• Metformin 

Most hormone therapies for HS are oral medications. It can be taken as a sole therapy for HS treatment but can be used in combination with other treatments. 

Retinoids are derived from Vitamin A or related to it, and have found use in medicine where they regulate epithelial (skin cell) growth. They work to help slow the production of skin cells and reduce inflammation. 

Some oral retinoids may be helpful in the treatment of HS. These can include:

• Isotretinoin 
• Acitretin 

These types of medications are often prescribed as a monotherapy or part of a combination therapy.

Corticosteroids for HS are generally administered either orally or through injection, and are used to reduce inflammation, decrease swelling, and help manage pain.

• Intralesional (injected) corticosteroids are used in moderate to severe cases and are injected right into the site of the lesion to aid in the healing of that specific area. (Kenalog injection)
• Oral corticosteroids can affect the entire body and are often used for short periods of time in HS  to help control a flare. Use of oral corticosteroids should be minimal as the side effects of long-term systemic steroid use are very serious.

Biologics are generally reserved for more severe cases of HS which aren’t responding to antibiotics, hormone therapy, or retinoids. Biologics work by interrupting immune system signals that cause inflammation. 

Biologics are a product that is derived from living organisms or contain components of living organisms, and are administered by injection or intravenous (IV) infusion either at home or in hospital/clinic by a medical professional. 

In Canada the only approved biologic for treatment of Hidradenitis Suppurativa is Adalimumab. 

Other biologics are being investigated for their efficacy in HS.

HS pain can be caused by numerous sources including lesions, abscesses, and scaring. Pain may also be caused by arthritic symptoms associated with HS. This pain can be debilitating, and may interfere with the patients quality of life, and therefore makes pain management an important aspect of treatment. 

This pain can vary from acute to chronic, inflammatory to non-inflammatory. 

Some medications used to treat HS could be:

• Lidocaine
• Non-steroidal inflammatory drugs (NSAIDs)
• Acetaminophen
• Opioids 

Topical pain medication (e.g. lidocaine) can occasionally be used to treat acute HS pain and can be applied directly to the area in question. 

Oral pain medications are typically preferred for managing pain. First line pain medications include acetaminophen and ibuprofen (NSAIDs).

Laser therapies are often reserved for moderate to severe HS but can also be used in mild cases.

There are several different types of laser treatments used to treat HS. Including laser hair removal, direct treatment of active lesions and scar reduction. Laser hair removal involves the laser energy being absorbed by the hair follicle destroying it and stopping regrowth without damaging the surrounding skin. It can be used directly over open wounds and penetrates deep enough to help treat inflammation. People with dark hair will enjoy the benefits of hair removal though it doesn’t work as effectively on light hair. This treatment is low discomfort with no recovery time needed.

Unfortunately this treatment is not generally covered under public or private health insurance and can be quite costly.

A variety of surgical options are available for the treatment of Hidradenitis suppurativa. Which surgery is chosen and whether surgery is necessary will depend on the severity of the disease.

Some surgical options used to treat HS include: 

• Deroofing: This technique is where the “roof” (the tissue on top of the abscess or tunnelling) is electro-surgically removed, which allows the wound to heal from the inside out. 
• Excision: This is a more invasive form of surgery, in which the surgeon will remove the affected tissue as well as some healthy tissue around it to help prevent the abscesses/tunnelling from coming back. In some cases this surgery may involve skin grafts. 
• Incision and Drainage: This is a procedure to quickly relieve pain in which your surgeon can cut open the abscesses and drain fluid, however this is temporary and HS often returns to the location later.