Hidradenitis :: Treatment of hidradenitis suppurativa
Hidradenitis suppurativa is primarily a disease of occlusion (obstruction) and inflammation of the apocrine (odor) sweat glands of the groin and axilla (armpit). It is similar to acne, which is a disease of the sebaceous (oil) glands in the skin. Hidradenitis develops when ducts from the apocrine glands to the skin surface become blocked, leading to a red swollen area on the skin and to the formation of cysts, infection and scarring.
Treatments may vary depending upon presentation and severity of the disease. Due to the poorly-studied nature of this disease, the effectiveness of the drugs and therapies listed below is not yet clear, and patients should discuss all options with their doctor or dermatologist. A list of treatments that are effective for some patients is as follows.
changes in diet
warm compresses, baths (to induce drainage)
intralesional corticosteroid injections (to reduce inflammation)
oral antibiotics (to treat inflammation and bacterial infection)
isotretinoin (Accutane?), a prescription-only oral acne treatment (benefits for HS are very controversial)
wide local excision (with or without skin grafting), or laser surgery
sub-cutaneous injection or IV infusion of anti-inflammatory (anti-TNF-alpha) drugs such as infliximab (Remicade?)and etanercept (Enbrel?). This use of the drugs is not currently FDA approved and is somewhat controvertial. It is also rarely covered by insurance.
Management of acute flare ups:
a very short course of systemic corticosteroids or intralesional steroids. Short courses of antibiotics are usually ineffective in long standing hidradenitis suppuritiva.
Long term management:
Treatment options include long-term antibiotics (e.g. systemic tetracyclines or macrolides in doses similar to those used in acne), dianette and acitretin.
Surgical treatment is an alternative if there is failure of medical therapy – the appropriate technique is via wide excision with secondary intention healing or split-skin grafting.
Additional measures that help to reduce the frequency and intensity of hidradenitis include:
? Wearing loose-fitting clothing
? Reducing activity that makes you sweat profusely
? Washing with Tea Tree oil soap may help reduce the burning and itching
? Losing weight.