It is difficult to control hidradenitis suppurativa with medical treatment. The best approach is to catch the disease in its early stages, and treat and control milder symptoms of the disease. Medical treatment means using medicines, either on the skin or by month. Medical treatment includes:
- Tropical anti-acne antibiotics and benzoyl peroxide. The antibiotics kill bacteria on the skin while the benzoyl peroxide is an antibacterial agent and also leads to drying of the skin. Benzoyl peroxide also encourages the skin to shed off the dead surface, which can help stop the blockage of pores.
- Antibiotic tablets - can be used when there are no abscesses. The goal is to try to stop the infection from spreading and to help the abscess heal more rapidly. Generally, a short treatment of antibiotics will last for two weeks. A prolonged course of antibiotics is usually used for their anti-flammatory action.
- The COCPs (the Pill) - are sometimes prescribed. A trial of up to 12-months may be needed before determining if the skin has improved. Some COCPs such as (Dianette or Yasmin) might be better than others. They counteract some of the more 'male' hormones effects such as skin oiliness and spots. Contraceptive pills are, of course, the only suitable for women. Not all women can safely use the Pill, as contraceptive pills can have serious side effects in some women. Your primary care physician can discuss with you whether it is safe to use the Pill.
- Retinoids. Acitretin (Neotiagason) - is a retinoid that has shown significant results. It may be used when other medicines have not been helpful. These are vitamin A-based medicines and should be prescribed only by a skin specialist (dermatologist). These medicines work by stopping the secretion of sebum from sebaceous glands. They also help the normal shedding of dead skin cells in the hair follicles, preventing pore blockage. It must not be taken in pregnancy due to the risk of birth defects.
- Corticosteroid tablets (steroids), - such as prednisolone, may be prescribed in short courses to reduce inflammation. Long courses of steroids can cause serious side effects such as 'thinning of the bones (osteoporosis), weight gain, high blood pressure, cataracts, and mental health problems.
- Medicines - that affect the immune system have been used with some success. These medicines can only be prescribed by a specialist (dermatologist) and your treatment must be carefully monitored. This is because there are potentially very serious side-effects such as kidney (renal) failure, and low blood counts (which can make you at risk of an overwhelming infection). Examples of medicines used are Anti-TNF medicines such as Infliximab (Remicade) or Dapsone (used to treat leprosy; used in hidradenitis suppurativa for its anti-inflammatory action).
Some of these new medicines are extremely expensive. The NHS limits the use of these medicines to certain medical conditions, such as inflammatory bowel disease, rheumatoid arthritis, and psoriasis.
Hidradenitis Surgical Options
The most common surgical procedure involves excision of the lesion which is wide and beyond the borders of the lesion. Chances of reoccurrence decrease, but there is the possibility that the disease might return in the distant future. Patients that undergo surgery should be informed before the surgery that the lesions might occur in areas not previously affected. Some studies show that after aggressive surgical excision, the hidradenitis suppurativa lesion reoccurred in about 33 percent of patients.
In many cases, wide surgical excision is not performed. A more limited surgery is performed, involving an incision of the roof of an abscess, or the sinus, or a curettage at the base of the lesion. The lesion is then allowed to heal. This procedure can be successful in many cases.
- Electrosurgery - is another option for hidradenitis suppurativa lesions. Electrosurgery may be a better option compared to conventional wide excision surgery.
Minor surgical procedures are:
- Drainage of the lesion
- Sinus tract electrocoagulation
- Simple excision of the lesion with direct closure of the site
- Placement or flaps with healing by secondary intention - the types of flaps used are: pedicle flaps, free flaps, cutaneous flaps, musculocutaneous flaps
- Skin grafts