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Hidradenitis suppurativa is a disease of chronic inflammation and infections of apocrine sweat glands located around your body. Medications and creams may provide temporary relief but more aggressive options like surgery may be your only option for help.

Hidradenitis suppurativa, or better known as acne inversa, is a debilitating disease that is found around your armpits, around your anal canal or located around skin creases. These are the areas of your body where apocrine sweat glands are most concentrated

Patients will suffer from swollen lumps just underneath the skin that can grow and burst. They are very painful and most often seen among: 

  • patients just entering puberty or
  • adults with imbalances in their sex hormones. [1]  

Hidradenitis suppurativa is a fairly common disease and is believed to affect up to 4 percent of the global population [2]. Not only is this a socially embarrassing situation for most teenagers and adults who suffer from this problem, if immediate treatments are not started, patients risk permanent fibrosis and scarring from these ruptured pores

Medicine offers several different therapies that you can try if you find you are suffering from this condition in order to prevent the worst case scenario from happening. [3] In this article, I will present some of the potential options for you to consider as well as the risks and benefits of each of these interventions. You may have read online that hidradenitis suppurativa treatment with surgery is your only option to consider but there may be more favorable alternatives for you. 

Treatment options for mild forms of the disease 

Generally, when an adolescent with an underlying predisposition for hidradenitis suppurativa begins to show signs of the disease, they will be presenting with a very mild form of the disease as follicles are still being formed as the body prepares for adult body composition. Because of the milder form of the disease, physicians are able to utilize less aggressive management approaches to try to treat the disease before long-term scarring can occur. The staple ingredient to this form of the disease relies on a combination of antibiotics. The earliest treatment that doctors will use would be topical creams of clindamycin or resorcinol creams. If the disease disappears, that is an ideal situation but in most cases, once topical creams halt, there will be a relapse of the skin irritation. 

When the disease becomes more persistent or bothersome, the next step is to make more aggressive treatments using antibiotic therapy that is ingested orally. The first-line treatment would be tetracycline with a combination of clindamycin and rifampin. This is determined to be a very effective therapy option when taking all these medications together but once patients stop the medications, the disease can not only relapse but it can even become more severe. Long-term therapies do exist in the form of retinoid medications but another consideration that patients need to be aware of is that this class of medication is effective but also teratogenic. This means that when patients are trying to become pregnant, there is a good chance that there will be severe developmental problems with the fetus and pregnancy is not recommended. [4]

As you can see, treating mild forms of hidradenitis suppurativa is not as simple as you may think. 

Treatment Options for Severe Forms of the Disease 

When more mild therapies are not working, the next step up in management approach would be hidradenitis suppurativa treatment with surgery. 

In one study conducted on patients who ultimately required surgery, it was determined that patients were typically in their 30s with 66 percent of patients already having at least one excision and drainage procedure and 90 percent receiving long-term antibiotic therapy. Among them, 88 percent of women had the worse symptoms in their underarms while 87 percent of men had the worse symptoms around their anal canals. Patients were offered either excision of the apocrine glands and primary closure or a wide excision with skin grafting if the disease was more widespread. At the conclusion of the study, it was determined that this was the way to find a definite cure for this condition and no relapses were reported once the glands had been removed. [5]

In another, more widespread retrospective cohort study done on 590 patients that were suffering from hidradenitis suppurativa, the effectiveness of surgery was analyzed more systematically. It was determined that the biggest risk factors for having hidradenitis suppurativa were white, male smokers with an underlying metabolic disorder known as Hurley III. In this investigation: 

  • nearly 70 percent of patients had a simple excision of the affected glands, 
  • 30 percent required an unroofing procedure
  • and drainage was done in only 3 percent of cases. 

Only 15 patients in this study had postoperative complications that were minor in nature. There was a recurrence of symptoms in 25 percent of cases with only 70 patients requiring an additional surgery to treat their condition. The risk of recurrence increased if the patients were younger and had multiple sites with abscesses at one time. [6]

This provides a more realistic outlook were patients can expect more benefit from a surgical procedure compared to traditional medications but there is still a real risk of having the problem return. 

Alternative newer treatment options 

Understandably, most people are not overly eager to go "under the knife" regardless of the effectiveness of that type of therapy but never fear, there are new treatments on the horizon that could be just what you are waiting for. A newer biological agent that has been released to the market goes by the trademark, Humira (adalimumab). This is an agent that attempts to suppress the cellular physiology that is occurring at the apocrine glands and has shown impressive results in stage III clinical trials. It was determined that when used on patients suffering from mild-to-severe forms of hidradenitis suppurativa, there was a reduction of abscesses and lesions in 50 percent of the patients compared to 26 percent responses in the placebo group. Patients also reported a reduction in the level of pain they experienced, roughly 50 percent, compared to only 20 percent seen in the placebo groups. The study concludes stating that Humira is a potential safe and effective therapy for patients suffering from this disease while patients can notice a response within the first 12 weeks. [7]

All in all, hidradenitis suppurativa treatment with surgery may be the most affordable and achievable treatment but as further research is done on biological agents like Humira, patients will potentially access to an alternative option with fewer side effects. 

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