Treatment Regimens

In general, the earlier the treatment begins, the better the outcome.

Another aspect of the treatment regimen to consider is the dose, which ideally should be as small as possible [1, 2] for the acute stage of HS. Fischer [3] called this "Röntgenkleinstdosen" ("very small Röntgen dose"), namely a treatment schedule in which only 0.05- to 0.2-Gy single doses are used. The total doses of these series amount to between 1 and 4 Gy. If the HS is chronic and recurrent, the success rate is not as good, and higher single doses of between 0.5 and 1 Gy have to be applied [4] (Table 23.2). In the case of chronic disease treated with the aforementioned doses, the recurrence rate is at least 38%, whereas with the early application of very small doses, the rate is only 19% [1]. Radiation therapy can be adapted easily to the depth of the lesion between 5 and 30 mm, and this is calculated using the "half value depth" (HVD). Machines that deliver the treatment are mostly of the superficial X-ray type with a radiation quality of 20-150 kV. The irradiation field is chosen to be as large as possible. In recurrent cases, two or more series may be applied, but a total dose of 12 Gy should not be surpassed.

Table 23.2. Practical guidelines: recommended dose schedule for the treatment of hidradenitis suppurativa. Radiation quality (kV and filter) depend on the depth of hidradenitis suppurativa

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