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Hidradenitis suppurativa: Diagnosis and treatment

How do dermatologists diagnose hidradenitis suppurativa?

To diagnose this skin disease, a dermatologist looks closely at the skin and asks some questions.

If your breakouts are leaking fluid, your dermatologist may swab a bit of the fluid onto a slide to find out if you have an infection. You also may need a blood test.

How do dermatologists treat hidradenitis suppurativa?

Dermatologists offer patients who have hidradenitis suppurativa (HS) many treatment options, including many different medicines. Surgery may be an option when HS is severe or fails to respond to other treatment.

Treatment can help patients with HS:

  • Clear or reduce breakouts

  • Get rid of scars and tunnels beneath the skin

  • Prevent new breakouts

Dermatologists frequently use the treatments listed below, so they have in-depth knowledge and experience using them.

Medicines used to treat HS

If you have HS, your dermatologist may include one or more of the following in your treatment plan:

  • Antibiotics: This is often part of the treatment plan. These drugs can reduce inflammation, fight infection, prevent HS from worsening, and stop new breakouts.

  • Acne washes and medicines: Acne treatments that you can buy without a prescription may be helpful. Using these products alone usually will not clear HS.

  • Bleach baths: If certain bacteria colonize (found on the surface of your skin) you, your dermatologist may recommend taking 5- or 10-minute bleach baths. You'd take this bath in your own bathtub at home. If a bleach bath is right for you, your dermatologist will tell you how to make one.

  • Biologics: These work on the immune system. Some, such as adalimumab, you inject yourself. Others require an infusion at a hospital or clinic. Some patients have seen long-term clearing of their HS with a biologic. Due to possible serious side effects, you should discuss the risks and benefits with your dermatologist.

    Biologic is the first FDA-approved treatment for hidradenitis suppurativa

    The U.S. Food and Drug Administration (FDA) approved the first treatment for HS in 2015. It is a biologic called adalimumab (ad-ah-lim-you-mab). In studies, the patients who received adalimumab had noticeably fewer abscesses and nodules.

    The FDA has approved adalimumab for people 12 years of age or older who have moderate (Hurley stage II) or severe (Hurley stage III) HS.

  • Corticosteroid injection into a breakout: Your dermatologist may inject this into a painful cyst to reduce pain and swelling.

  • Corticosteroid pills: This medicine reduces inflammation, which can help clear HS and prevent new breakouts.

  • Diabetes drug: Metformin has been approved to treat adult-onset diabetes. It may also help people who have HS and a condition called metabolic syndrome.

  • Hormone therapy: Some women who have HS get relief by taking birth-control pills, a medicine called spironolactone, or another medicine that regulates hormones. These medicines can decrease pain and the amount of fluid draining from the breakouts.

  • Methotrexate (severe HS only): This medicine is used to treat cancer and certain other medical conditions, such as severe psoriasis. It works on the immune system and may help control HS in some patients.

  • Oral retinoid: A few patients with HS are helped.

  • Radiation therapy: This treatment exposes the body to radiation, so it is used less often today than in the past. Some patients have seen their HS clear. Be sure to talk with your dermatologist about the short- and long-term risks to your body.

  • Wound dressings: If the HS causes tunnels beneath your skin, you will need to treat these as you would wounds.

Surgical treatment for HS

When HS grows deep into the skin, medicine alone may not be effective. Your dermatologist may recommend a surgical procedure. The following can be performed in a dermatologist’s office or clinic:

  • Laser surgery: This treatment is showing promise. Some patients clear after several treatments. Lasers are proving effective at clearing new and deep HS breakouts. This treatment may be helpful because it destroys the hair follicles.

  • Deroofing: This surgery may be an option for patients who have painful HS that repeatedly returns. The surgeon turns deep, painful HS into scars.

  • Drain or incise: During the surgery, the dermatologist drains one or two lesions or cuts them out. This can bring short-term relief, but the HS can return.

  • Excision: This involves surgically cutting out the HS and some normal-looking skin. Because the wound is deep, the area needs to be covered with a skin graft (skin removed from another part of your body) or skin flap (skin from nearby is pulled over to cover the wound). HS does not return to the treated area, but it can develop nearby.

No one treatment works for everyone who has HS. Sometimes, a patient needs to try a few different treatments to find one that works.

Outcome: Lifestyle changes can be effective

Many people have HS for life. Studies continue to show that making certain lifestyle changes can help tremendously. Weight loss has proven so effective that some patients say maintaining a healthy weight prevents HS breakouts.

Alikhan A, Lynch PJ, Eisen DB. "Hidradenitis suppurativa: A comprehensive review." J Am Acad Dermatol 2009;60(4):539-61.

Fardet L, Dupuy A, Kerob D, et al. “Infliximab for severe hidradenitis suppurativa: Transient clinical efficacy in 7 consecutive patients.” J Am Acad Dermatol 2007;56(4):624-8.

Grant A, Gonzalez T, Montgomery M, et al. “Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: A randomized, double-blind, placebo-controlled crossover trial.” J Am Acad Dermatol 2010;62(2):205-17.

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