Hidradenitis Suppurativa Treatment Guidelines

Disease Assessment and Treatment Algorithm

• The American College of Dermatology recommends evaluating disease severity using the Hurley staging system to guide appropriate treatment selection 1
• The Hidradenitis Suppurativa Clinical Response (HiSCR) measures reduction in inflammatory lesions and is used to monitor treatment response 3, 4
• Patient-reported outcomes, including pain (Visual Analog Scale) and quality of life (Dermatology Life Quality Index), should be assessed 5, 1

Treatment Options

• For mild disease (Hurley Stage I), first-line treatment is topical clindamycin 1% solution/gel twice daily for 12 weeks 1, 2
• For moderate disease (Hurley Stage II), first-line treatment is tetracycline 500 mg twice daily for up to 4 months 3, 1
• For severe disease (Hurley Stage III), first-line treatment is adalimumab 160 mg at week 0, 80 mg at week 2, then 40 mg weekly starting at week 4 4, 2

Adjunctive Therapies

• Weight loss should be encouraged for patients with obesity 1, 2
• Smoking cessation is important as tobacco use is associated with worse outcomes 1, 7
• Pain management with NSAIDs can provide symptomatic relief 7
• Appropriate wound care for draining lesions is essential 5, 7

Treatment Monitoring and Follow-up

• Treatment response should be assessed after 12 weeks using HiSCR and patient-reported outcomes 1
• For adalimumab, if clinical response is not achieved after 16 weeks, consider alternative treatments 4, 2