Hidradenitis Suppurativa Treatment
Hidradenitis is an ongoing and difficult management problem.
Antiperspirants, shaving, chemical depilatories, and talcum powder are probably not responsible for the initiation of the disease. Cigarette smoking may be a major triggering factor. Smoking cessation should be encouraged.
Tretinoin cream (0.05%) may prevent duct occlusion, but it is irritating and must be used only as tolerated. Large cysts should be incised and drained. Smaller cysts respond to intralesional injections of triamcinolone acetonide (Kenalog, 2.5 to 10 mg/ml). Weight loss helps to reduce activity. Many patients will not comply with the suggestion to reduce.
Actively discharging lesions should be cultured. Repeated bacteriologic assessment is advisable in all cases. Oral contraceptives do not seem to work as well as they do with acne.
Antibiotics are the mainstay of treatment, especially for the early stages of the disease. Long-term oral antibiotics such as tetracycline (500 mg bid), erythromycin (500 mg bid), doxycycline (100 mg bid) or minocycline (100 mg bid) may prevent disease activation. Lower doses may effective for maintenance once control is established. Topical clindamycin may also be effective
Isotretinoin (1 mg/kg/day for 20 weeks) may be effective in selected cases. The response is variable and unpredictable and complete suppression or prolonged remission is uncommon. Early cases with only inflammatory cystic lesions in which undermining sinus tracts have not developed have the best chance of being controlled. Severe cases have also responded.
Surgical excision is at times the only solution. Residual lesions, particularly indolent sinus tracts, are a source of recurrent inflammation. Local excision is often followed by recurrence.
Early radical excision of sinus tracts is the operative treatment of choice. The method of reconstruction whether it is wide excision of affected skin, and healing by granulation or applying split skin grafts or transposed or pedicle flaps has no influence on recurrence and should be chosen with respect to the size and location of the excised area.