Medical Treatments of Hidradenitis Suppurativa: More Options, Less Evidence

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by painful recurrent nodules and abscesses that often rupture and lead to significant pain with the formation of sinus tracts and scarring. This common disorder (affecting approximately 1% of the population) can be psychologically debilitating and have a significant negative impact on the patient’s quality of life. With the recent publication of Guidelines for HS Treatment, produced by the European Dermatology Forum, as well as recent evidence-based approach to the treatment of HS, we can now develop a comprehensive, holistic, and rational approach to the treatment of this chronic, debilitating, devastating, recurrent inflammatory disorder of the skin. In this article, we review the evidence for many of the second and third line therapies for the treatment of HS. Because very few randomized, controlled trials are available for the treatment of HS, therapies presented are mainly based on case series and case reports. All the therapies reviewed in this article have Category of Evidence IV and Strength of Recommendation D with the exception of acitretin, zinc gluconate, and metformin, which have a Category of Evidence III and Strength of Recommendation C.

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