Hidradenitis Supurativa Treatment Guidelines

Introduction to Treatment

The American College of Dermatology recommends clindamycin 1% topical solution applied twice daily for 12 weeks as first-line treatment for mild disease (Hurley Stage I) 1
For moderate disease (Hurley Stage II), the American College of Dermatology suggests clindamycin 300 mg oral twice daily plus rifampicin 600 mg daily for 10-12 weeks as a preferred regimen 4, 1, 2
The American Academy of Dermatology recommends adalimumab as the first-line biologic treatment for severe or refractory disease, with a dosing regimen of 160 mg at week 0, 80 mg at week 2, and 40 mg weekly thereafter 4, 1, 2

The Hurley staging system is used to determine disease severity, with Stage I being mild, Stage II moderate, and Stage III severe 1
The Visual Analog Scale (VAS) is used to assess pain, and the Dermatology Life Quality Index (DLQI) is used to evaluate the impact of the disease on quality of life 1

For mild disease (Hurley Stage I), clindamycin 1% topical solution is applied twice daily for 12 weeks, and may be combined with benzoyl peroxide or chlorhexidine to reduce the risk of Staphylococcus aureus resistance 1, 2
For moderate disease (Hurley Stage II), clindamycin 300 mg oral twice daily plus rifampicin 600 mg daily for 10-12 weeks is a preferred regimen, with a response rate of 71-93% 4, 1, 2
For severe or refractory disease, adalimumab is the first-line biologic treatment, with a dosing regimen of 160 mg at week 0, 80 mg at week 2, and 40 mg weekly thereafter 4, 1, 2

Surgery is often necessary for long-term cure, especially in advanced disease, with options including deroofing, radical excision, and wound closure 1, 4
The extent of surgical excision influences therapeutic outcome, with studies showing non-recurrence rates of 81.25% after wide excision 1

Lifestyle modifications, including smoking cessation and weight loss, are critical for disease management 1, 2, 3
Management of comorbidities, including depression, anxiety, and cardiovascular risk factors, is essential 1
Symptomatic management, including pain control and wound care, is also important 1, 3

Patients should be reevaluated at 12 weeks using the VAS, inflammatory lesion count, DLQI, and HiSCR for those on biologic therapy 1, 3
Treatment should be escalated if there is an inadequate response after 12 weeks, with options including switching to clindamycin plus rifampicin or adalimumab 4, 1, 2