Table 4. Advantage and Disadvantages of Medical HS treatments
Treatment |
Advantages |
Disadvantages |
Clindamycin/rifampin |
Standard Treatment, in large study of Stage I patients experienced remission Cheap, tolerated by most HS pts |
In women yeast infections, RB GI intolerance, possible hepatic issues, Rifampin has many drug interactions and decreases the effectiveness of OCP (same for 2 boxes below)
|
Minocycinline /rifampin |
More effective than ABC1 perhaps, cheap, generics cheap, |
In women yeast infections, RB, extended release minocycline is expensive GI intolerance, possible hepatic issues Mino-headaches and rare side effects, HSS |
Fluoroquinolones, metronidazole, rifampin |
Might work when ABC1 and ABC2 fail, can be all generic and cheap |
Fluoroquinolones tendon rupture CNS issues in particular in elderly, yeast infections ,GI upset, RB Metronidazole-acral neuropathy, can't use Etoh |
Spironolactone |
Cheap, can reduce menstrual flares, |
Diuretic, depletes K, needs lab monitoring, neural & muscular SEs, blood increased clotting |
Cyproterone acetate and ethinyloestradiol |
Cheap, reduces mentstrual flares |
Not available in US, increased clotting |
OCP |
Cheap, except branded products with drospirenone which may be best type of OCP for females with HS |
Increased risk of blood clots in particular if drospirenone is part of OCP |
Intralesional Corticosteroids (ILK) |
Quick acting, can have cumulative effect abating or burning out HS |
Rare adrenal suppression, limited duration of effectiveness of 2-4 weeks, painful for patient |
Dapsone |
May Work where ABC fail |
Neuropathy, hemolytic anemia, regular CBCs methemoglobinemia, response not durable, Should be given with cimetidine. inconsistent |
Istretinoin, |
Helped >20% of patients |
Most patient have no response, xerosis, needs OCP in women, ,Pancreatitis, elevated lipids, HSS, mood effect GI upset other SE |
Topical clindamycin |
Standard treats, few SE, Generic and thus inexpensive |
Might not work, require constant application, not that useful in Stage 2 or 3 disease |
Topical dapsone |
Few SEs, soothing vehicle |
expensive, no published reports to show it helps |
Infliximab |
Very effective TNFaB, can be obtained via hospitalization |
Expensive, IV access, no scars ablation, more SE than adalimumab, should be given with MTX, Waning effect over time, can promote development of SCC |
Adalimumab |
Effective, ease of administration |
Expensive, does not resolve scars, Waning effect over time, can promote development of SCC |
IVAB |
Limited reports show dramatic effect |
Expensive, little data, need IV access, long term use could select out for RB |
Cyclosporine |
Few reports show it tremendous anti inflammatory effectiveness, safer to use for months over oral corticosteroids, generic available |
Required chemical and vital sign monitoring can promote SCC, renal SE |
Finasteride, |
Generic, few reports support use |
Sexual SE, gynecomastia |
Dutasteride |
Expensive, More effective testosterone blocker than finasteride |
SE similar and greater than finasteride, more risk of gynecomastica, uncertain effect of blocking DHT1 |
Acitretin, oral alitretinoin, etretinate |
Might resolve follicular occulsion, other + immune effects. |
Similar side effects of isotretinoin, expensive, few studies, xerosis |
Corticosteroids oral IM high dose |
Cheap, can reduce inflammation |
Long term use has many side effects |
Zinc gluconate 90mg |
Cheap, little strong data |
Not for severe disease, copper should accompany it |
Leuprolide Acetate, Lutamide ,Degarelix gonadotropin-releasing hormone agonist |
Strong hormonal suppression |
Not proven for HS, extreme hormonal SE |
Botulinum toxin |
Might alter neural factors, alters skin flora due to decrease sweating |
Expensive, unproven |
IVIG |
Might work if all else fails |
Expensive, unproven |
PDGF, GCSF |
Promote healing |
Expensive, unproven |
Surgical and laser treatment options not revivewed. SE=side effects, EtOH=Alcoholic beverages, hypersensitivity syndrome=HSS, GI=gastrointestinal side effects, Granulocyte-macrophage colony-stimulating factor=GCSF, Platelet Derived Facetor+ PDGF, MTX=methotrexate,+=positive, SCC=squamous cell cancer, RB=resistant bacteria, Pt=patients, IVAB=intravenous antibiotics, in particular ertapenem and ceftriaxone, K=potassium. It should be noted that all oral IV or IM medications can cause skin rash.