Researchers at the Department of Dermatology of the Henry Ford Hospital in Detroit presented an approach to treating hidradenitis suppurativa after a systematic review of studies depicting the efficacy of various treatment options.
The 20-year review incorporated 62 studies, including 25 related to medical treatment through antibiotics or biologics, 30 related to surgical treatments and seven involving miscellaneous treatments. Investigators graded the studies A (n=4), B (n=16) or C (n=42) according to the quality and validity of the resulting data, and developed their suggested treatment approach based on the effectiveness of the various therapies.
For patients with Hurley Stage I mild hidradenitis suppurativa (HS), researchers recommended a 1% topical lotion or solution of clindamycin, as well as monthly therapy with an Nd:YAG or carbon dioxide laser. They also suggested 90 mg zinc gluconate daily as a possible adjunctive treatment, but added that patients should be counseled regarding potential gastrointestinal effects.
The researchers suggested that Stage II patients should receive 300 mg clindamycin and 300 mg rifampin twice daily for 10 weeks, while also being informed of potential side effects — most notably severe diarrhea. Nd:YAG treatment for at least three to four monthly sessions also was considered an option. Biological agent infliximab was listed as another potential option in the event of a patient’s unresponsiveness or inability to tolerate the other treatments.
Stage III patients, investigators wrote, could benefit from the treatments recommended for stages I and II patients, but surgical options should be considered in severe cases. The study analysis indicated that surgical excision followed by a primary closure with a resorbable gentamicin sulfate-collagen sponge, which reduced the occurrence of postoperative infection, led to faster healing and resulted in fewer complications.
“Although progress has been made in the last 20 years of research, most treatment options for HS are largely based on trial-and-error patient care and physician clinical experience,” the researchers wrote. “Until additional randomized controlled studies of existing and novel treatments are performed, the evidence-based treatment approach offered in this review will aid clinicians in managing the treatment of HS.”