A Systematic Review of Treatments for Hidradenitis Suppurativa

OBJECTIVES: To conduct a systematic review of the effectiveness of various modalities to treat hidradenitis suppurativa (HS) and to establish recommendations on its appropriate management. DATA SOURCES: MEDLINE, Cochrane, and PubMed databases. STUDY SELECTION: English-language prospective, retrospective, and case studies describing at least 4 patients with HS. DATA EXTRACTION: Data quality and validity were addressed by multiple reviewers using independent extraction. DATA SYNTHESIS: Studies were categorized as treatments using antibiotics, biological agents, laser surgery, excisional surgery, or miscellaneous modalities. Of 62 publications included in the review, 4 studies met criteria to be assigned the highest grade for quality of evidence. CONCLUSIONS: Shown to be effective treatments for HS were a clindamycin-rifampin combination regimen, a course of infliximab, monthly Nd:YAG laser sessions, and surgical excision and primary closure with a gentamicin sulfate-collagen sponge. Most therapies used to treat HS were supported by limited or weak scientific evidence. A treatment approach is presented based on the evidence and on clinical experience at the Follicular Disorders Clinic, Department of Dermatology, Henry Ford Hospital, Detroit, Michigan. This review emphasizes the need for large randomized controlled trials to evaluate treatment options for HS.