Using Surgical and Medical Techniques to Manage Your Hidradenitis Suppurativa Patients
University of Southern California
Los Angeles, CA
Hidradenitis suppurativa (HS) can be very debilitating for patients and difficult for providers to effectively treat. In this session, Jennifer Hsiao, MD discussed both medical and surgical techniques to manage this disease. She began by reviewing the Hurley staging system, common HS comorbidities, and key considerations when deciding how to approach treatment. She reiterates that optimal management of HS involves a multifaceted approach, which includes managing friction/irritation, metabolic dysfunction, hormones, dysbiosis, follicular occlusion, and immune dysregulation.
Next, Dr. Hsiao focused on specific treatments for mild HS. She highlighted the importance of lifestyle modifications such as smoking cessation, weight loss, and avoidance of tight-fitting clothes. For topical treatments, she recommended clindamycin 1% gel or lotion and resorcinol 15% ointment. For increased efficacy, she suggested combining these with antiseptic washes such as chlorhexidine or benzoyl peroxide washes. Dr. Hsiao then discussed several systemic medications for mild HS, including oral doxycycline or minocycline 100 mg twice daily for 8-12 weeks, oral dapsone 50 to 100 mg daily, and oral clindamycin 300 mg twice daily with rifampin 300 mg twice daily for 12 weeks.
For moderate-to-severe HS, Dr. Hsiao shared that she likes to use biologics, especially adalimumab which is FDA approved for HS, and infliximab and secukinumab which are not yet approved for HS. In the clinical trial for adalimumab, at week 12 up to 58.9% of patients on weekly adalimumab achieved HiSCR, defined as at least a 50% reduction in inflammatory lesion count (abscesses + inflammatory nodules) and no increase in abscesses or draining fistulas when compared with baseline, compared to 27.6% on placebo. Two phase 3 clinical trials for secukinumab are underway, and so far, more patients have achieved HiSCR at week 16 than placebo.
Dr. Hsiao concludes the session with procedural management of HS. Her recommendations included intralesional triamcinolone 10 mg/mL – 40 mg/mL, incision and drainage for acute relief of abscesses, botulinum toxin injections, laser therapy, and deroofing or wide local excision. She also teases a few emerging medical therapies for HS, including anti-IL-1, anti-IL-36, and kinase inhibitors.