Treatment of Hidradenitis Suppurativa Hurley Stage I

This most limited form of disease is the most amenable to medical therapy, and can often be held in check by prophylactic treatment. In Stage I disease the patients often have only a few flares per year. Treatment is therefore most often aimed at reducing the duration of the flares (Table 25.2), and may consist of:

Table 25.2. Treatment of HS Hurley Stage I disease

Topical treatment:

Clindamycin 1% (lotion) Clindamycin 2% (cream) Resorcinol

Short course systemic treatment: Tetracycline

Erythromycin or other macrolides Amoxicillin + clavulanic acid Clindamycin Others

Adjuvant preventive therapy: Azelaic acid Zinc gluconate

■ A short course of systemic antibiotics (7-10 days). A large number of various antibiotics have been tried in this situation. The patient's previous experience may help the choice.

■ Intralesional steroids.

Such a treatment aimed at shortening the duration of a flare cannot be effective unless it is given very early, i.e., within hours of the first symptoms of a new flare. In the case of a short course of systemic antibiotics, that means that the patient has to keep the drug with him/her and use it before seeing the doctor. In the case of intralesional steroids the specialist has to be reached in an emergency.

If flares are more frequent most patients benefit from adjuvant preventive therapy, which may include azelaic acid applied daily. For this group of patients prophylactic therapy combined with treatment of flares may allow them to gain control of their disease, and in some cases the routine use of adjuvant preventive therapy alone may suffice to control the disease. For patients with frequent (one per month or more) and severe flares, treatment should however be intensified to the level required for Stage II disease (see Table 25.3).

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