| >> How can HS be treated? |
There are many ways in which your doctor can help you. A sensible combination of medication and surgical treatments helps most HS sufferers. In general terms, early hidradenitis suppurativa and acute flares are usually treated with medications, whereas hidradenitis suppurativa that has been going for a long time may need surgery. Frequent acute episodes occurring in the same area, with proven bacterial infection, usually mean that you have a sinus or abscess that may require surgical treatment. The treatments listed below have been divided into but often a combination of these is used. There are a number of things that people with HS can do to help reduce symptoms. These are described in the section ‘How can I help myself?’ Unfortunately, there have been very few good studies done to identify the most reliable medical treatment for HS. The treatments available are effective for some people though. About 1 in 5 people experience some relief from HS with medication (1 in 10 with antibiotics).2 Treatments are often similar to those given for acne.
If you have a flare-up, your doctor may give you drugs to help reduce the flare-up and to help with the pain. You will usually take these for a short time and stop them when the flare-up subsides (see below).
For most people, HS is a disease which has quiet periods and others where the disease flares up. The purpose of suppressive treatment is to try to reduce how often and how badly the flare-ups occur and to improve the condition between flare-ups. It is likely that you will need to take this medication for many months (see below). Treatment of acute painful flare-ups These can be treated with antibiotics, corticosteroids and painkillers. Often a combination of these will be used. Antibiotics Acute, painful flares of the condition are usually treated as bacterial infections with short courses of antibiotics. Most patients with HS find that this treatment doesn’t really help, particularly if they have had HS for some time. Low doses of corticosteroids taken by mouth (e.g. prednisolone) are sometimes used for several weeks to months to reduce acute flares. They are sometimes given in combination with antibiotics for their anti-inflammatory effect. Occasionally corticosteroids may be injected directly into individual lesions to decrease inflammation. Painkillers such as codeine, paracetamol, or non-steroidal anti-inflammatory drugs are almost always required for treatment of more severe flare-ups. Your doctor will also suggest you rest to allow the flare-up to subside.
HS can be a very stubborn disease to treat but there are many treatments that your doctor can prescribe to try to keep the disease at bay. Nothing is licensed for HS. Your doctor may suggest you try several different medications/doses or combination of medications before finding the right suppressive treatment for you. You will need to take most of these treatments for at least 3 months before the doctor can properly assess whether or not they are working. So you need to be prepared for the process of finding the right treatment to take a while. Remember, just because one treatment has not worked does not mean that another will not. It’s just that some treatments work better for some people than others. Unfortunately, there has not been enough research done yet for doctors to be able to predict in advance who will benefit (or not) from different treatments. The following treatments can be used as suppressive treatments: Long courses (up to six months) of oral antibiotics are often helpful, particularly earlier on in the disease process. Examples are
Courses of treatment can be repeated to deal with subsequent flare-ups. Long-term use of topical clindamycin (a lotion applied to the skin) has been found to be as good as oral tetracycline antibiotics.6,7 For women, taking an oral contraceptive pill that has a high oestrogen to progestogen ratio and a low-androgenic progestogen can be helpful. For women whose HS flares up before each period, tablets known as antiandrogens (e.g. cyproterone acetate) can be useful. This is usually given in combination with oestrogen in a combined contraceptive pill (Dianette). Side effects Oral contraceptive pills in women may very occasionally make HS worse. Acitretin is a drug closely related to Vitamin A. It is quite effective in some patients. Side effects Isotretinoin (Roaccutane) There is little evidence that this is effective for HS but it is occasionally used. Side effects Azathioprine and cyclosporin are sometimes used to treat HS. They have been shown to be of some use but are reserved for severe disease due to risk of serious side effects.10 Side effects This is a very new group of medications which have shown significant promise in the treatment of severe forms of HS. They haven’t yet been fully assessed with regards to their potential side-effects and limitations. They are also very expensive and not widely available. Surgery is usually reserved for people with disease that has not responded well to medications. However, some doctors think that radical surgery (see radical excision) early in the course of severe disease is the best option as it is the only treatment that can give a lasting remission in the disease in the treated areas. Decisions about surgery are best discussed in person with the doctor looking after you as there are many different types of surgery that have been used for HS. The following section gives you a brief overview of the most common surgical methods used to treat HS:
Radiotherapy Radiotherapy has been used in the past and it worked for some people in the short-term.3 However, it is not commonly used nowadays because we now know about the risks that it can cause skin breakdown and skin cancers several years after treatment. Dressings You may need to apply dressings to the affected areas see 'What sort of dressings should I use?' |
