Hidradenitis Suppurativa Treatment Guidelines
Introduction to Treatment
- The British Journal of Dermatology recommends starting with oral tetracyclines (doxycycline or lymecycline) for at least 12 weeks as first-line systemic therapy, escalating to clindamycin 300 mg plus rifampicin 300 mg twice daily for 10-12 weeks if unresponsive, and offering adalimumab 40 mg weekly for moderate-to-severe disease that fails conventional antibiotics 1, 2, 3
Disease Severity Assessment and Initial Management
- The British Journal of Dermatology suggests documenting Hurley stage at baseline for the worst-affected region to guide treatment selection 4
- The British Journal of Dermatology recommends immediate dermatology referral for Hurley Stage III (severe) disease 3, 4
- The British Journal of Dermatology advises screening all patients at baseline for depression, anxiety, cardiovascular risk factors, and inflammatory bowel disease if persistent GI symptoms are present 1, 2, 3, 4
Systemic Antibiotic Therapy
- The British Journal of Dermatology recommends doxycycline 100 mg once or twice daily or lymecycline 408 mg once or twice daily for at least 12 weeks as first-line therapy 1, 2, 3, 4, 5
- The Journal of the American Academy of Dermatology suggests clindamycin 300 mg twice daily plus rifampicin 300 mg twice daily for 10-12 weeks for patients unresponsive to tetracyclines 1, 2, 3, 6, 4, 5
Biologic Therapy
- The British Journal of Dermatology recommends adalimumab 40 mg weekly for moderate-to-severe HS unresponsive to conventional systemic therapy 1, 2, 3, 4, 5
- The Journal of the American Academy of Dermatology suggests infliximab 5 mg/kg at weeks 0, 2, 6, then every 8 weeks for patients unresponsive to adalimumab 1, 2, 3, 6, 4, 5
Surgical Interventions
- The Journal of the American Academy of Dermatology states that surgery is often necessary for lasting cure, especially in advanced disease with sinus tracts and scarring 6, 5, 8
- The British Journal of Dermatology recommends extensive/radical excision to minimize recurrence rate when conventional systemic treatments have failed 1, 2, 3, 6, 4, 5
Essential Adjunctive Measures
- The British Journal of Dermatology advises smoking cessation referral where relevant 1, 2, 3, 4, 5
- The British Journal of Dermatology recommends weight management referral where relevant 1, 2, 3, 4, 5
- The Praxis Medical Insights suggests pain management with NSAIDs for symptomatic relief 5, 8