The following treatments and medications are commonly used in the treatment of Hidradenitis Suppurativa [HS]. Unless your General Practitioner has particular expertise in treating HS you will normally be referred to a consultant dermatologist. All treatments below should be discussed with your dermatologist. The decision on treatment will be based on treatment history, medical history, stage of disease and ultimately, patient preference. As treatment options for HS are vast, only the more common have been listed here. To view a short video about HS treatment, please click here.
The most common antibiotics prescribed to treat HS are used for their anti inflammatory properties rather than to treat infection.
The most effective treatment for HS is a combination of Rifampicin and Clindamycin which is given for 2-3 months. This will bring about a remission in at least three quarters of patients. This remission can be long lasting and further relapses can be treated in the same way. A blood test to monitor liver function is usually performed at the start of treatment and again after one month. Side effects are usually minimal but include nausea, vomiting and diarrhoea [which can occasionally be severe].
Other anti-inflammatory antibiotics such as erythromycin, oxytetracycline, minocycline and lymecycline are sometimes used in courses of at least three months. They are effective to some extent but are gradually being replaced by Rifampicin and Clindamycin.
Flucloxacillin, amoxicillin, co-amoxiclav and Penicillin V are often used to treat HS. They all belong to the penicillin family and are useful for treating secondary infections such as cellulitis, but are not effective when used alone. Common side effects include nausea, vomiting and diarrhoea. Some people can have allergic reactions to penicillin based drugs. They may also reduce the effectiveness of the oral contraceptive pill.
Prednisolone belongs to the corticosteroid class of drugs, which are hormones produced naturally in the human adrenal cortex. Prednisolone is commonly used to treat Crohn's disease, colitis, multiple sclerosis and it has also been used an an immunosuppresive drug for organ transplants. Short courses are sometimes used in HS is for its ability to control inflammation. Possible side affects may include fluid retention, weight gain, constipation and mood swings.
Retinoids are vitamin A based drugs used in medicine for the regulating epithelial cell growth. Systemic retinoids such as isotretinoin are commonly used for the treatment of acne. They must not be taken during pregnancy as they can cause birth defects. Adverse effects include dryness of lips, skin and eyes. While retinoids are an excellent treatment for acne they are less effective in HS.
Anti-androgens work by inhibiting the the biologic effects of androgens, and are most commonly found in oral contraceptives. Dianette contains cyproterone acetate and is sometimes given to women with HS. Some improvement can occur but the effects are limited. Adverse affects are rare, but can include deep vein thrombosis, liver toxicity and depressive mood changes.
Cyclosporin is an immunosuppressant drug that is widely used after organ transplantation to prevent organ rejection. Adverse effects can include vomiting, diarrhoea, high blood pressure, numbness, kidney and liver dysfunction. Cyclosporin has shown to have beneficial effects in the management of HS, with some patients achieving short term remission (<4 months). This drug can also be used to treat psoriasis, dermatitis and rheumatoid arthritis.
Dapsone is another anti-inflammatory drug which is occasionally used to treat HS. Adverse effects include nausea, headache, and rashes, more rarely, jaundice and anaemia.
Infliximab is an anti-TNF drug, used to treat Crohn's disease, psoriasis, rheumatoid arthritis and ulcerative colitis. It is normally administered by intravenous infusion, typically at 6-8 week intervals, and at a clinic or hospital. Adverse side affects of this drug may include blood disorders, infection, solid tissue cancers. Although it is usually very effective in treating HS its use is limited by its high cost. However patients who fail to respond to one or more of the above measures may be considered for treatment by a dermatologist.
Adalimumab (Humira) is currently the only drug that is licenced for the treatment of moderate to severe HS. Adalimumab is a TNF inhibiting anti-inflammatory biologic medication. Adalimumab binds to tumor necrosis factor-alpha (TNFα). TNFα normally binds to TNFα receptors, which leads to the inflammatory response of autoimmune diseases. By binding to TNFα, adalimumab reduces this inflammatory response. It is administered via a syringe or self-injecting pen every 1-2 weeks.
Where medical treatments have failed surgery may be considered. The decision on which method to take depends on the region and severity of the HS. For small single nodules, incision and drainage is normally the first procedure as this will give some temporary pain relief. However repeated small incisions can lead to more inflammation and scarring in the long run. For Stage 2 HS, Carbon Dioxide laser surgery can be performed This is followed by secondary intention healing, where the wound is left to heal naturally. Stage 3 HS is normally treated by wide scale excision [removal] of the affected area.