Symptom management, lifestyle changes recommended for hidradenitis suppurativa

Improving basic diet and wellness habits, along with treatment of flares with clindamycin 1%, are some of the recommended approaches to minimizing severe complications of hidradenitis suppurativa, according to recent findings.

“Hidradenitis suppurativa is a chronic debilitating skin disease characterized by painful dermal abscesses, subcutaneous inflammatory nodules, draining sinuses and hypertrophic scars,” Michelle Militello, MS, of Rocky Vista University College of Osteopathic Medicine in Parker, Colorado, and colleagues wrote.

The researchers suggested that early recognition and management of HS is essential because of the long-term physical and psychological consequences of untreated disease.

There is no cure for HS. Rather, the condition should be managed using methods to improve symptoms and quality of life. Prevention of disease progression is critical to minimize recurrences. Existing lesions should be treated to reduce pain and drainage, according to the findings.

Regarding specific recommendations, maintaining a healthy body weight with diet and exercise topped the list due to the correlation between obesity and HS. Those who need to lose weight should reduce daily caloric intake by 500 kcal to 1,000 kcal, according to the researchers, who also recommended aerobic exercise for 30 to 60 minutes 3 to 5 days a week.

While the researchers recommend patients see a nutritionist to formulate a diet plan, they also said some nutritional interventions may help improve HS, such as taking vitamin D, vitamin B12 and zinc, avoiding dairy and brewer’s yeast and following a Mediterranean diet.

The researchers also recommended wearing loose-fitting clothing in breathable materials, such as cotton; warm compresses to alleviate pain; antibacterial washes and, with physician guidance, weekly diluted bleach baths; avoiding shaving with a razor; and quitting smoking.

In terms of pharmacologic options, clindamycin 1% may be used twice daily to reduce HS flares. Doxycycline or minocycline dosed 100 mg twice daily for 3 months may also have utility in managing symptoms and flares. Isotretinoin dosed 0.45 mg/kg per day is another possible treatment option.

For severe disease, clinicians may try biologic tumor necrosis factor inhibitors.

Incision and drainage is one surgical approach that may have utility in severe HS, along with carbon dioxide laser incision.

“Preventing outbreaks can be the cornerstone to disease management and should be a vital component of treatment plans to best serve patients,” the researchers concluded.