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Treatment Options for Severe Cases of Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) often poses a therapeutic challenge to physicians treating the condition. Severe cases can be refractory to a multitude of therapies, both surgical and medicinal alike. In this video, Stephanie Lehrhoff, MD, describes different approaches to HS treatment, including a new therapy that has shown promise in severe cases that otherwise fail to respond to the standard of care.

Surgical options for HS resolution include excisions with grafting and punch debridement with mini-unroofing. In situations where surgery is risky or unsuccessful, drug therapies may be administered. According to one French study, infliximab is a potent TNF-a inhibitor that can reduce disease severity by 50%. Adalimumab is considered to be less efficacious than infliximab, but allows for subcutaneous insertion, as opposed to intravenous delivery. Additional efficacious drugs include some oral retinoids and immunosuppressants. A 2013 study finds that biologic agent Anakinra, an interleukin-1 receptor antagonist (IL-1RA), may be effective when many other treatment options have failed. Laser treatments targeting the offending follicles are also available via the 1064 nm Nd: YAG laser.

Stephanie Lehrhoff, MD