In the past 5 years, there have been several advances in the treatment of hidradenitis suppurativa (HS), according to a new review published in JAMA

For this review, researchers searched literature databases for recent studies (September 2011 to May 2017) on the treatment of HS and excluded any reviews, guidelines, conference abstracts, and trials that included <10 patients. “[HS] is relatively common, with the prevalence of 0.05% to 4.10%, yet many patients receive inadequate treatment,” the authors write.

HS is diagnosed by lesion morphology (nodules, abscesses, tunnels, scars), location (axillae, inframammary folds, groin, perigenital, or perineal), and lesion progression (2 recurrences within 6 months or chronic or persistent lesion for ≥3 months). In addition, patients often report significant disability and comorbidities, including obesity, metabolic syndrome, diabetes, and arthritis. They may also be at an increased risk of all-cause mortality with an incidence rate ratio of 1.35 (95% CI: 1.15 to 1.59). 

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With regard to treatment, combination therapy with clindamycin and rifampin or ertapenem, followed by combination rifampin, moxifloxacin, and metronidazole for 6 months was found to be effective. Adalimumab demonstrated efficacy in a significant proportion of patients and treatment with interleukin (IL)-1 and IL-12 receptor subunit beta 1 (Rb1) antibodies may also be beneficial. 

Procedures such as tissue-sparing excision with electrosurgical peeling (STEEP) and carbon dioxide laser treatments are also available but the authors note limited evidence on clinical outcomes. 

Hidradenitis suppurativa should be considered in the differential diagnosis of nodular lesions or sinus tracts present in the axillae, groin, perineal, and mammillary fold regions,” concluded lead author Ditte Marie Lindhardt Saunte, MD, PhD, from Zealand University Hospital, Denmark.

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