Hidradenitis Suppurativa Treatment Guidelines

First-Line Therapies

• The American Academy of Dermatology recommends topical clindamycin 1% solution/gel twice daily for 12 weeks for localized disease 1, 2
• The American Academy of Dermatology suggests tetracycline 500 mg twice daily for 4 months for more widespread disease 1, 3

Second-Line Therapy

• The American Academy of Dermatology recommends clindamycin 300 mg twice daily with rifampicin 600 mg once daily for 10 weeks if first-line therapy fails 1, 3

Third-Line Therapy

• The American Academy of Dermatology recommends adalimumab 160 mg at week 0, 80 mg at week 2, then 40 mg weekly for moderate-to-severe HS 1, 3, 6

Surgical Options

• The American Academy of Dermatology suggests deroofing or excision for recurrent nodules and tunnels 4
• The American Academy of Dermatology recommends wide local excision for extensive chronic lesions 4

Weight Loss and HS

• The American Academy of Dermatology recommends weight loss as an adjunctive therapy for HS patients with obesity, but not as a primary treatment modality 4, 5
• Obesity is associated with increased HS severity and is considered a modifiable risk factor 5

Recommendation Rationale

• The American Academy of Dermatology and other guidelines do not include tirzepatide or other GLP-1 receptor agonists in their treatment algorithms for HS 1, 2, 3, 4, 6
• Adalimumab is FDA-approved for moderate-to-severe HS and should be considered before other treatments 6, 3

Clinical Considerations

• For patients with moderate HS and obesity who have failed first-line therapies, the evidence-based next steps would be to trial clindamycin/rifampicin combination therapy 1, 3
• If unsuccessful, proceed to adalimumab therapy 1, 6, 3
• Consider surgical intervention for recurrent nodules and sinus tracts 4
• Continue to encourage weight loss through conventional means as an adjunctive approach 4, 5