Treatment of Hidradenitis Suppurativa (Hurley Stage II) in Adult Patients
Clinical Scenario
This protocol addresses adult patients (not pregnant) with Hidradenitis suppurativa classified as Hurley stage II — defined by one or a limited number of sinuses and/or scarring within a body region.
Disease Staging
Hurley stage I is characterized by recurrent nodules and abscesses with minimal scar. Stage II is characterized by 1 or a limited number of sinuses and/or scarring within a body region. Stage III involves multiple or extensive sinuses and/or scarring. This protocol targets the intermediate stage II presentation.
Treatment Approach
Management begins with lifestyle counseling, followed by a combination of topical and intralesional skin-directed therapies. The full protocol also specifies an oral antibiotic course and an energy-based procedural option. Complete regimen details, sequencing, and dosing are in the full protocol.
Treatment Goals
The primary targets are reduced pustules and a reduction in abscesses.
References
DOI: 10.1016/j.jaad.2019.02.067
- Hurley stage I is characterized by recurrent nodules and abscesses with minimal scar, Hurley stage II is characterized by 1 or a limited number of sinuses and/or scarring within a body region, and Hurley stage III is characterized by multiple or extensive sinuses and/or scarring.
- Counsel smoking cessation.
- Screen for obesity and counsel weight loss.
- Topical clindamycin may reduce pustules in HS, but it carries a high risk of bacterial resistance.
- A prospective case series on the effect of intralesional triamcinolone, 10 mg/mL (0.2–2.0 mL), into inflamed HS lesions demonstrated significant reductions in physician-assessed erythema, edema, suppuration, and size.
- Tetracyclines are recommended in mild-to-moderate HS for a 12-week course or as long-term maintenance when appropriate.
- An Nd:YAG laser is recommended in patients with Hurley stage II or III disease on the basis of RCT and case series data and in patients with Hurley stage I disease on the basis of expert consensus.
- A 12-week randomized, placebo-controlled trial of 27 subjects with Hurley stage I or II disease demonstrated reduced pustules but no effect on inflammatory nodules and abscesses.
- A single randomized controlled trial (RCT) comparing tetracycline, 500 mg twice daily, with topical clindamycin demonstrated a 30% reduction of abscesses in both groups, but changes in patient-reported outcomes were not significant.
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