Therapeutic Options for Hidradenitis Suppurativa: An Update

Hidradenitis suppurativa (HS) is chronic deteriorating skin condition characterized by severe, deep inflammatory lesions, often referred to as acne inversa. Intertriginous regions, such as the axillae, groins (genital, anal, and perianal areas), infra- and intermammary skin, buttocks, and upper thighs, are usually affected although there can also be other areas, such as the neck and the stomach. Patients with severe conditions are affected by several painful nodules and draining sinuses, which exude fluid that often smells, and the fear that those new lesions can erupt at any time, requiring incision and drainage, corticosteroid, or surgical injection. Topical clindamycin lotion or resorcinol cream can be effective long-term treatment in mild disease, while tetracycline is mostly systemic first-line choice. Although antibiotics can help to reduce inflamed lesions, but recurrence is significant after discontinuation. If patients do not respond well to these common medical procedures, the next step is to use biologics such as adalimumab or infliximab. Several anti-inflammatory medications such as fumarate, dapsone, and cyclosporine have been also recommended for the treatment of HS. Surgical procedures, particularly when sinuses or scares are present, are often important for healing. The HS clinical interpretation and patients’ expectations should be used as a basis for each patient therapy.