Treatment Options for HS

Gina Mangin, MPAS, PA-C: The treatment options that we have for HS [hidradenitis suppurativa] are extensive. We know that HS is this chronic, recurrent, inflammatory disease that’s involving the hair follicle. The only FDA-approved medication that we have for HS is adalimumab, which is an injection that patients administer themselves, but there are other things that we use that aren’t necessarily FDA approved. There are tons of medical literature out there supporting the use of these medications, which include oral antibiotics, intralesional steroid injections, and oral immunosuppressive medications. Other things we will use are medications that may affect the hormone imbalances, meaning oral birth control pills, or oral spironolactone. We will also use topical antibiotics, topical resorcinol. So, the list is large in terms of the treatment options that we have out there.

The next question is, how do we treat these patients and how do we decide which treatment modalities to use? The first question is, is their disease mild or is it more moderate and severe? If it’s mild, then we can probably just use some topical antibiotics. If they have a flare, then we can use intralesional cortisone injection. But if they’re having a flare, the key is that we must calm that inflammation down. Often when we’re going to start with oral anti-inflammatory antibiotics, if we see that these flares are continually progressing and we’re seeing that they have scarring along with the tunnels and the tracks forming, then many times we’re going to combine medications such as adalimumab and oral antibiotics but also…surgical treatments as well. I failed to mention earlier that those are treatments too—surgical treatments, removing those cysts or deroofing those cysts. When your patients’ symptoms are severe, they’re going to need both medical and surgical intervention.

Transcript edited for clarity