Treatment of Hidradenitis Suppurativa Hurley Stage II

Patients seen at the specialist level are frequently Stage II patients. The treatment aims to cure these patients or at least reduce them to Stage I disease. The presence of sinus tracts and scarring requires a combined treatment involving both medical and surgical therapies. The balance between the two depends on the amount of scarring and permanent suppuration present. The medical therapy aims to control acute inflammation and may also be used to prepare the patient for surgery.

For patients with little scarring and much inflammation, intensive, long-term antibiotic therapy with systemic clindamycin and rifam-

Table 25.3. Treatment of HS Hurley Stage II

Medical treatment (systemic only): Clindamycin + rifampicin Dapsone

Systemic adjuvant or maintenance therapy: Zinc gluconate Tetracyclines

Surgical treatment: Exteriorization Local excision Laser evaporation

Table 25.4. Treatment of HS Hurley Stage III. (TNF Tumor necrosis factor)

Medical treatment (palliative): Corticosteroids Ciclosporin Methotrexate TNF-alpha inhibitors

Surgical treatment: Wide excisions Radiation therapy?

picin is recommended. Treatment should last for 3 months. If pain, suppuration and frequency of flares are reduced to an acceptable level, a maintenance treatment with tetracyclines or high-dosage zinc or dapsone may offer long remissions. In some patients the level of improvement is so high as to permit the use of Stage I therapy, i.e., therapy of flares only.

For patients with scarring and sinus tracts the medical treatment should always be supplemented with local surgery, either using cold steel or laser evaporation. In milder cases exteri-orization of sinus tracts may suffice, whereas actual excisions may be necessary for larger lesions. Limited excisions are particularly useful when an abscess-sinus tract recurs frequently with flares at the same location. This kind of limited surgery may be performed in the outpatient setting with local anaesthesia and is well accepted by the patients who are frequently reluctant to have major excisions. On the other hand, general experience shows that the larger the excision, the lower the potential for recurrence. So a balance between the advantages and drawbacks of the two approaches has to be weighed up by the patient (see Table 25.3).

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