HS is not an easy disease to treat. Often standard therapies fail, and both patient and physician are left with a therapeutic challenge. Most often one of two general approaches is used in off-label/experimental therapy. One avenue of approach is to regard the disease as a predominantly inflammatory disease, and consequently treat with immunosuppressive drugs as in so many other dermatological diseases. The use of topical immunosuppressants is rarely sufficient, and systemic therapy has been tried with corti-costeroids, ciclosporin, methotrexate, dapsone and TNF-alpha inhibitors. All these treatments require special precautions, but may be useful for gaining control over an otherwise debilitating disease.
The other avenue of approach is to regard the presence of microbes as the primary pathogenic event and treat heavily with antibiotics. Most available antibiotics have been used to varying effect in individual cases.
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