Treatment of Hidradenitis Suppurativa Hurley Stage II After First-Line Therapy Failure in an Adult

This protocol covers the management of adult, non-pregnant patients with Hidradenitis suppurativa at Hurley stage II — one or a limited number of sinuses and/or scarring within a body region — whose initial treatment regimen did not achieve the required goals.

Clinical Scenario

Hurley stage II is characterized by 1 or a limited number of sinuses and/or scarring within a body region. When the targets of the first-line regimen are not met, an escalated, structured approach is indicated for this adult population.

Previous Treatment — Failure Condition

First-line therapy did not achieve the required goals

The prior regimen included smoking cessation and weight loss counselling, topical clindamycin, intralesional triamcinolone, oral tetracycline (12-week course), and Nd:YAG laser to the affected body region. The treatment goals of reduced pustules and reduction in abscesses were not met — escalation to this protocol is now warranted.

Next-Line Approach

This protocol involves an oral combination antibiotic strategy; for appropriate female patients, hormonal agents are also considered. A specific surgical modality is addressed for qualifying lesion types. The complete regimen, decision criteria, and sequencing are available in the full protocol.

Instant Access to Structured Evidence-Based Regimens

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.

Clindamycin and rifampin in combination is effective as a second-line treatment for mild-to-moderate disease or as a first-line or adjunct treatment in severe disease.

Hormonal agents, including estrogen-containing combined oral contraceptives, spironolactone, cyproterone acetate, metformin, and finasteride, should be considered in appropriate female patients, either as monotherapy for mild-to-moderate HS or in combination with other agents for more severe disease.

CO2 laser excision is recommended in patients with Hurley stage II or III disease with fibrotic sinus tracts.

View source ↗