Effectively Treating Hidradenitis Suppurativa

Theodore Rosen, MD, details his top tips for treating hidradenitis suppurativa.

Theodore Rosen, MD, professor of dermatology at Baylor College of Medicine in Houston, Texas, discussed how to effectively treat hidradenitis suppurativa (HS) last week at the Society for Dermatology Physician Assistants Annual Summer Meeting in Austin, Texas. Rosen is also speaking today at the Maui Derm NP+PA Summer 2022 meeting in Colorado Springs, Colorado from June 22-25.1

Rosen started off by stating that while adalimumab (Humira; AbbVie) is approved to treat HS, he finds that it only helps sometimes. “I have better luck when I can get it or I can get some samples, or I save up some samples of secukinumab (Cosentyx; Novartis). To my experience, [secukinumab] works better than adalimumab,” he said.

However, bimekizumab (UCB Biopharma), and interleukin (IL)-17A and IL-17F inhibitor, is on its way to a potential approval from the US Food and Drug Administration (FDA) and could be beneficial for treating HS. It was supposed to be approved for psoriasis already, says Rosen, but was delayed because of a manufacturing issue, not because of an issue with the safety and efficacy of the medication. Also, ustekinumab (Stelara; Janssen) has been shown to help in HS treatment, but only for short-term use which can help with the initial hump.

“I give almost everybody who shows up with HS an antibiotic to start with. But remember, this is not an infection. This is not something you want to treat with an antibiotic every single day. I don’t care which antibiotic; it’s not the long-term treatment,” said Rosen.

He noted that finasteride has been shown to be beneficial for the treatment of HS in about 70% of men but does not work well for women.

Additionally, if the patient is a smoker, Rosen urged clinicians to tell their patient to stop smoking, as smoking can exacerbate the disease. “Remember is this called ‘smokers boils’ in Europe. Smoking absolutely makes [HS] worse,” he said.

Another treatment mentioned was the use of skin-tightening lasers such as the Sciton because the heat from the lasers helps relieve symptoms of HS, according to Rosen. Specifically, he goes over the affected area multiple times until the area is warm and he performs this treatment about once per month.

Rosen concluded by recommending intralesional injections of corticosteroids, which have been shown to help with the treatment of HS, and most patients receive immediate benefit from it; however, he said, this is not a long-term treatment.

Reference

1. Rosen T. Ask the Expert. Presented at: Society for Dermatology Physician Assistants Annual Summer Meeting. June 16-19, 2022. Austin, Texas.