How is hidradenitis suppurativa treated?

Although there is no cure for hidradenitis suppurativa, early diagnosis and treatment help prevent the disease from getting worse and forming additional scars. Symptoms appear and disappear and vary from person to person. Many treatments are available and usually a combination of the following treatments is tried. Treatment choice depends on the severity of hidradenitis suppurativa.

Initial treatments for mild disease may involve home remedies including:

  • Sit in a warm bath and/or apply warm compresses to the affected area for 10 minutes at a time.
  • Apply topical cleansing agents, including antibacterial soaps, antiseptics, and acne washes to reduce/kill bacteria.
  • Take anti-inflammatory medications, such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and celecoxib (Celebrex®).
  • Wear loose-fitting clothing to prevent rubbing against the skin.
  • Maintain a proper weight. Being overweight causes more friction on the skin in the areas affected by this condition.

When painful skin lesions are present (moderate disease), treatments may include:

  • Corticosteroids, such as prednisone, to reduce pain and swelling.
  • Anti-inflammatories, such as ibuprofen (Advil®, Motrin®), naproxen (Aleve®), and celecoxib (Celebrex®).
  • Antibiotics, such as tetracycline, erythromycin, minocycline and amoxicillin/clavulanate potassium. An erythromycin-based skin cream is also sometimes prescribed. These are used to treat infected lesions.
  • Adalimumab (Humira®), a tumor necrosis factor alpha inhibitor, is the first biologic agent approved by the Food and Drug Administration to treat moderate to severe hidradenitis suppurativa.
  • Other medications that can be tried include retinoids (acne-fighting drugs) and birth control pills (to address the hormonal cause of hidradenitis suppurativa).

Severe cases of hidradenitis suppurativa are treated using the following surgical procedures:

  • Laser. A laser is used to clear new and deep seated breakouts.
  • Deroofing. Breakouts are turned into scar tissue (a procedure called deroofing).
  • Draining abscesses. Abscesses can be drained to provide some relief.
  • Excision (cutting out) of the lesions and skin grafting. In this type of surgery, larger areas of the skin and scar tissue are removed. A skin graft from a healthy area of the body may be needed to replace the lost skin.

What are the complications of hidradenitis suppurativa?

Hidradenitis suppurativa occurs in cycles throughout a patient’s lifetime, with periods of breakouts and healings. In some cases, the disease progresses and causes abscesses (pus-containing areas of infection) to form deep within skin tissue. Continued healing and scarring can cause that area of the skin to become thick and in extreme cases, the scarring makes the affected area firm and difficult to move. Continued healing and scarring can also cause fistulas to form inside the body. Fistulas are hollow passages that are painful and require surgery to repair.

What are the outcomes after treatment for people with hidradenitis suppurativa?

Some people with the disease have recurrent outbreaks for the rest of their lives. Some people who treat the disease early with surgery have no further symptoms. In rare cases, hidradenitis suppurativa clears up without any treatment.

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