Treatment of Extensive Perianal Hidradenitis Suppurativa

Disease Assessment

The British Journal of Dermatology recommends that a 35-year-old male with extensive hidradenitis suppurativa of the perianal region covering a 15x15cm area is classified as Hurley stage III (severe) disease based on the extensive involvement and likely presence of interconnected sinus tracts and scarring 1, 2
Immediate referral to dermatology secondary care is indicated for Hurley stage III disease, as recommended by the British Journal of Dermatology 1, 3
Pain assessment using Visual Analog Scale (VAS) and quality of life measurement using Dermatology Life Quality Index (DLQI) should be performed, according to Praxis Medical Insights 4

The British Journal of Dermatology recommends immediate treatment with combination antibiotics, including Clindamycin 300 mg twice daily with rifampicin 300 mg twice daily for 10-12 weeks, for perianal hidradenitis of this extent 1, 3, 5
Pain management with NSAIDs should be initiated, as recommended by the British Journal of Dermatology 1
Provide appropriate dressings for pus-producing lesions, according to the British Journal of Dermatology 1
Screen for depression/anxiety, which is common in HS patients, as recommended by the British Journal of Dermatology 2, 6
Screen for cardiovascular risk factors (BP, lipids, HbA1c), according to the British Journal of Dermatology 1
Address modifiable risk factors, including offering smoking cessation and weight management if applicable, as recommended by the British Journal of Dermatology 1, 5

The British Journal of Dermatology recommends surgical referral to a hidradenitis suppurativa surgical multidisciplinary team as the definitive treatment for extensive perianal hidradenitis (15x15cm) 1, 3

If surgery is contraindicated or patient declines, adalimumab (Humira) is FDA-approved for moderate to severe hidradenitis suppurativa, however, for extensive perianal disease of this magnitude, surgical intervention remains the definitive treatment, as recommended by the British Journal of Dermatology 1