Abstract
Hidradenitis suppurativa (HS) is not easily treated. Although not uncommon, HS is
often misdiagnosed outside specialized clinics and inappropriately treated as a simple
boil or abscess. In recent years, guidelines have been developed on the basis of expert
opinion and the available literature.
A multifaceted approach is necessary as HS lesions include both inflammation (amenable
to medical treatment) as well as fibrosis (amenable to surgery only). The recommended
antiinflammatory therapies encompass both antimicrobials and regular anti-inflammatory
drugs. We have, therefore, reviewed treatments with the following agents: clindamycin,
tetracycline, rifampicin, ertapenem, dapsone, triamcinolone, infliximab, adalimumab,
and anakinra. The development of new medical treatments, however, is an ongoing effort,
and important new data have been presented since the publication of the guideline.
The current approach to the management of fibrotic lesions is surgery. It is important,
as manifest fibrosis is generally not susceptible to medical treatment. Here minor
excision, carbon dioxide-laser, and major surgery are discussed, and current evidence
supporting their use is provided.
A comprehensive three-pronged approach with adjuvant therapy, medical therapy, and
surgery is recommended. The importance of adjuvant therapy, that is, pain management,
wound care, and attention, is stressed. Adjuvant therapy not only plays a major role
in patients’ perception of a successful treatment but also is of practical importance
to their coping and self-management.
HS presents a significant unmet need, and this review provides a mechanistic update
on the current real-world therapeutic option for the management of this distressing
disease.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Clinics in DermatologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa.Rev Endocr Metab Disord. 2016; ([Epub ahead of print])
- European S1 for the treatment of hidradenitis suppurativa/acne inversa.J Eur Acad Dermatol Venereol. 2015; 29: 619-644
- Clinical practice. Hidradenitis suppurativa.N Engl J Med. 2012; 366: 158-164
- Hidradenitis suppurativa/acne inversa: criteria for diagnosis, severity assessment, classification and disease evaluation.Dermatology. 2015; 231: 184-190
- Diagnostic delay in hidradenitis suppurativa is a global problem.Br J Dermatol. 2015; 173: 1546-1549
- Hidradenitis suppurativa: epidemiology and scope of the problem.J Am Acad Dermatol. 2015; 73: S4-S7
- The prevalence of hidradenitis suppurativa and its potential precursor lesions.J Am Acad Dermatol. 1996; 35: 191-194
- Cardiovascular disease risk factors in patients with hidradenitis suppurativa: a systematic review and meta-analysis of observational studies.Br J Dermatol. 2015; 173: 1142-1155
- Incidence of cancer among patients with hidradenitis suppurativa.Arch Dermatol. 2001; 137: 730-734
- Characterization of obesity rates for dermatologic ambulatory office visits to United States physicians.J Dermatolog Treat. 2016; ([Epub ahead of print]): 1-5
- Management of hidradenitis suppurativa in patients with metabolic comorbidities.Ann Dermatol. 2016; 28: 147-151
- Body composition and basal metabolic rate in Hidradenitis Suppurativa: a Danish population-based and hospital-based cross-sectional study.J Eur Acad Dermatol Venereol. 2016; 30: 980-988
- Coexistence of hidradenitis suppurativa with autoimmune thyroiditis: report of three cases.Dermatology. 2016; 232: 162-164
- Hidradenitis suppurativa and metabolic syndrome: a comparative cross-sectional study of 3207 patients.Br J Dermatol. 2015; 173: 464-470
- Association of metabolic syndrome and hidradenitis suppurativa.JAMA Dermatol. 2014; 150: 1273-1280
- Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis.J Am Acad Dermatol. 2014; 71: 1144-1150
- The prevalence of metabolic syndrome in patients with hidradenitis suppurativa.J Am Acad Dermatol. 2014; 70: 699-703
- Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis.Dermatol Online J. 2013; 19: 18558
- Hidradenitis suppurativa: viewpoint on clinical phenotyping, pathogenesis and novel treatments.Exp Dermatol. 2012; 21: 735-739
- Increased prevalence of metabolic syndrome in patients with acne inversa.PLoS One. 2012; 7: e31810
- Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies.J Am Acad Dermatol. 2008; 59: 596-601
- Factors associated with point-of-care treatment decisions for hidradenitis suppurativa.JAMA Dermatol. 2016; 152: 553-557
- The handicap of hidradenitis suppurativa.Dermatol Clin. 2016; 34: 17-22
- Risk factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study.Br J Dermatol. 2014; 171: 819-824
- Psychiatric comorbidities in 3207 patients with hidradenitis suppurativa.J Eur Acad Dermatol Venereol. 2015; 29: 371-376
- Depression in patients with hidradenitis suppurativa.J Eur Acad Dermatol Venereol. 2013; 27: 473-478
- Psychosocial impact of hidradenitis suppurativa: a qualitative study.Acta Derm Venereol. 2011; 91: 328-332
- Psychophysical aspects of hidradenitis suppurativa.Acta Derm Venereol. 2010; 90: 264-268
- Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity.Br J Dermatol. 2009; 161: 831-839
- Hidradenitis suppurativa.J Eur Acad Dermatol Venereol. 2009; 23: 985-998
- The ABC of hidradenitis suppurativa: a validated glossary on how to name lesions.Dermatology. 2016; 232: 137-142
- Hidradenitis suppurativa or acne inversa. A clinicopathological study of early lesions.Br J Dermatol. 1996; 135: 721-725
- Imaging of hidradenitis suppurativa.Dermatol Clin. 2016; 34: 59-68
- Ultrasound examination of hidradenitis suppurativa.Actas Dermosifiliogr. 2015; 106: 49-59
- Ultrasound in-depth characterization and staging of hidradenitis suppurativa.Dermatol Surg. 2013; 39: 1835-1842
- A 3-D ultrasound study of sinus tract formation in hidradenitis suppurativa.Dermatol Online J. 2013; 19: 18564
- Ultrasound aids in diagnosis and severity assessment of hidradenitis suppurativa.Br J Dermatol. 2010; 162: 1400-1402
- Real-time compound imaging ultrasound of hidradenitis suppurativa.Dermatol Surg. 2007; 33: 1340-1342
- The microbiology of hidradenitis suppurativa.Dermatol Clin. 2016; 34: 29-35
- Bacteriology of hidradenitis suppurativa/acne inversa: a review.J Am Acad Dermatol. 2015; 73: S12-S18
- Bacterial pathogens associated with hidradenitis suppurativa, France.Emerg Infect Dis. 2014; 20: 1990-1998
- Topical treatment of hidradenitis suppurativa with clindamycin.Int J Dermatol. 1983; 22: 325-328
- Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa.J Am Acad Dermatol. 1998; 39: 971-974
- Antibiotic treatment of hidradenitis suppurativa.Ann Dermatol Venereol. 2012; 139 ([in French]): 532-541
- Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa-acne inversa: a prospective study on 23 patients.J Eur Acad Dermatol Venereol. 2014; 28: 125-126
- Rifampicin and clindamycin for hidradenitis.J Am Acad Dermatol. 2011; 64: 790
- The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa.Dermatology. 2009; 219: 143-147
- Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients.Dermatology. 2009; 219: 148-154
- Clindamycin and rifampicin combination therapy for hidradenitis suppurativa.Br J Dermatol. 2006; 154: 977-978
- Dramatic reduction of clindamycin plasma concentration in hidradenitis suppurativa patients treated with the rifampin-clindamycin combination.Eur J Dermatol. 2014; 24: 94-95
- Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa.Dermatology. 2011; 222: 49-58
- Efficacy of ertapenem in severe hidradenitis suppurativa: a pilot study in a cohort of 30 consecutive patients.J Antimicrob Chemother. 2016; 71: 513-520
- Dapsone therapy for hidradenitis suppurativa: a series of 24 patients.Dermatology. 2011; 222: 342-346
- Hidradenitis suppurativa intralesional injections with corticosteroids-HILIC.Exp Dermatol. 2016; 25: 11
- Hidradenitis suppurativa and Crohn’s disease: response to treatment with infliximab.Inflamm Bowel Dis. 2001; 7: 323-326
- Treatment of hidradenitis suppurativa with etanercept injection.Arch Dermatol. 2010; 146: 501-504
- Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality.Br J Dermatol. 2016; 174: 970-978
- A double-blind placebo-controlled randomized trial of adalimumab in the treatment of hidradenitis suppurativa.Br J Dermatol. 2011; 165: 391-398
- Adalimumab for the treatment of moderate to severe Hidradenitis suppurativa: a parallel randomized trial.Ann Intern Med. 2012; 157: 846-855
- HiSCR (Hidradenitis Suppurativa Clinical Response): a novel clinical endpoint to evaluate therapeutic outcomes in patients with hidradenitis suppurativa from the placebo-controlled portion of a phase 2 adalimumab study.J Eur Acad Dermatol Venereol. 2016; 30: 989-994
- Assessing the validity, responsiveness and meaningfulness of the Hidradenitis Suppurativa Clinical Response (HiSCR) as the clinical endpoint for hidradenitis suppurativa treatment.Br J Dermatol. 2014; 171: 1434-1442
- Safety and efficacy of adalimumab in patients with moderate to severe hidradenitis suppurativa: results from first 12 weeks of PIONEER I, a phase 3, randomized, placebo-controlled trial.J Am Acad Dermatol. 2015; 72: AB60
- Efficacy and safety of adalimumab in patients with moderate to severe hidradenitis suppurativa: Results from PIONEER II, a phase 3, randomized, placebo-controlled trial.J Am Acad Dermatol. 2015; 72: AB45
- Adalimumab improves health-related quality of life (HRQoL) in patients with moderate to severe hidradenitis suppurativa (HS): results from the first 12 weeks of PIONEER II.J Am Acad Dermatol. 2015; 72: AB38
- Adalimumab improves treatment satisfaction with medication (TS-M) in patients with moderate to severe hidradenitis suppurativa (HS) in a 12-week randomized controlled trial (PIONEER II).J Am Acad Dermatol. 2015; 72: AB39
- Adalimumab is associated with reduced skin pain in patients with moderate to severe hidradenitis suppurativa (HS): results from the first 12 weeks of PIONEER II.J Am Acad Dermatol. 2015; 72: AB39
- Adalimumab improves treatment satisfaction with medication (TS-M) in patients with moderate to severe hidradenitis suppurativa (HS) in a 12-week randomised controlled trial (PIONEER I).J Investig Dermatol. 2014; 134: S31
- HUMIRA improves health-related quality of life (HRQoL) in patients with moderate to severe hidradenitis suppurativa (HS): results from the first 12 weeks of PIONEER I.J Investig Dermatol. 2014; 134: S34
- Two cases of severe hidradenitis suppurativa with failure of anakinra therapy.Br J Dermatol. 2015; 172: 810-811
- An open-label study of anakinra for the treatment of moderate to severe hidradenitis suppurativa.J Am Acad Dermatol. 2014; 70: 243-251
- Successful treatment of severe hidradenitis suppurativa with anakinra.JAMA Dermatol. 2013; 149: 1192-1194
- Failure of anti-interleukin-1 therapy in severe hidradenitis suppurativa: a case report.Dermatology. 2013; 226: 97-100
- Safety and Efficacy of Anakinra in Severe Hidradenitis Suppurativa: A Randomized Clinical Trial.JAMA Dermatol. 2016; 152: 52-59
- Cyclosporine treatment of severe hidradenitis suppurativa—a case series.J Dermatolog Treat. 2016; 27: 247-250
- Intralesional triamcinolone acetonide for keloid treatment: a systematic review.Aesthet Plast Surg. 2008; 32: 705-709
- A review of wide surgical excision of hidradenitis suppurativa.BMC Dermatol. 2012; 12: 9
- Hidradenitis suppurativa: surgical and other management techniques.Dermatol Surg. 2012; 38: 517-536
- Wide excision and healing by secondary intent for the surgical treatment of hidradenitis suppurativa: a single-center experience.J Plast Reconstr Aesthet Surg. 2016; 69: 554-566
- Recurrence of hidradenitis suppurativa after surgical management: a systematic review and meta-analysis.J Am Acad Dermatol. 2015; 73: S70-S77
- Recurrence rate and patient satisfaction of CO2 laser evaporation of lesions in patients with hidradenitis suppurativa: a retrospective study.Dermatol Surg. 2015; 41: 255-260
- Secondary intention healing in skin surgery: our own experience and expanded indications in hidradenitis suppurativa, rhinophyma and non-melanoma skin cancers.J Eur Acad Dermatol Venereol. 2013; 27: 1015-1021
- A comparison of skin grafting and healing by granulation, following axillary excision for hidradenitis suppurativa.Ann R Coll Surg Engl. 1983; 65: 235-236
- The use of silastic foam dressing in the treatment of advanced hidradenitis suppurativa.Br J Surg. 1980; 67: 277-280
- Long-term results of wide surgical excision in 106 patients with hidradenitis suppurativa.Dermatol Surg. 2000; 26: 638-643
- Pain and inflammation in hidradenitis suppurativa correspond to morphological changes identified by high-frequency ultrasound.J Eur Acad Dermatol Venereol. 2015; 29: 527-532
- Mild to moderate hidradenitis suppurativa treated with local excision and primary closure.J Eur Acad Dermatol Venereol. 2012; 26: 898-902
- Effect of localized surgical excisions in hidradenitis suppurativa.J Am Acad Dermatol. 1988; 18: 1103-1107
- Deroofing: an effective method for treating chronic diffuse hidradenitis suppurativa.Dermatol Surg. 2016; 42: 273-275
- Surgical procedures in hidradenitis suppurativa.Dermatol Clin. 2016; 34: 97-109
- Surgical treatment of sinuses by deroofing in hidradenitis suppurativa.Dermatol Surg. 2012; 38: 494-497
- Deroofing: a tissue-saving surgical technique for the treatment of mild to moderate hidradenitis suppurativa lesions.J Am Acad Dermatol. 2010; 63: 475-480
- Surgical treatment of chronic hidradenitis suppurativa: CO2 laser stripping-second intention technique.Dermatol Surg. 2016; 42: 429-431
- Outcomes of treatment of nine cases of recalcitrant severe hidradenitis suppurativa with carbon dioxide laser.Br J Dermatol. 2008; 159: 1309-1314
- Surgical treatment of chronic hidradenitis suppurativa: CO2 laser stripping-secondary intention technique.Br J Dermatol. 1994; 131: 551-556
- Therapy of suppurative hidradenitis using the CO2-laser. Case report and literature review.Schweiz Rundsch Med Prax. 1993; 82 ([in German]): 941-945
- Acne inversa (hidradenitis suppurativa): a review with a focus on pathogenesis and treatment.Indian Dermatol Online J. 2013; 4: 2-11
- Management of severe anogenital acne inversa (hidradenitis suppurativa).Dermatol Surg. 2012; 38: 110-117
- Chronic pain management in dermatology: a guide to assessment and nonopioid pharmacotherapy.J Am Acad Dermatol. 2015; 73: 563-573
- Treatment of hidradenitis supprurativa associated pain with nonsteroidal anti-inflammatory drugs, acetaminophen, celecoxib, gabapentin, pegabalin, duloxetine, and venlafaxine.Dermatol Online J. 2013; 19: 20616
Article info
Identification
Copyright
© 2016 Published by Elsevier Inc.
