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  • Denise Panter-Fixsen

The HS Treatment Journey: Your Options

We all know how confusing and frustrating the Hidradenitis Suppurativa treatment journey can be. Currently, Humira is the only FDA approved treatment for HS, however, there are other "off label" treatment options as covered in this article. Treatment options for pediatric and adolescent patients may vary from those covered in this article; please consult your pediatric dermatologist for additional information.

Treatment decisions should be based on disease severity and on made on an individual basis. There are multiple treatment options for HS, which do not have to always include antibiotics, Accutane or acitretin.


As advocates, we like do not recommend Accutane/Isotretinoin, acitretin, or long term antibiotic use. Please visit our Nutrition section for alternative treatments for HS.


We understand that in most countries, including the US and UK, antibiotics and Accutane may be the first treatments offered for HS. Neither antibiotics or Accutane should be taken long term. Please review the treatment suggestions below which may present options you may not have been aware of in the past.


STEROID INJECTIONS

These are also known as kenalog, triamcinolone and kenacort injections. These injections are done directly into your affected HS areas.


Click here to read additional information regarding Kenalog or Steroid Injections.


BOTOX INJECTIONS


Botox injections may help with inflammation and those who have problems with sweating.


Click here to read additional information regarding Botox Injections.


ANTI-INFLAMMATORY MEDICATIONS (prescription and non-prescription)


Diclofenac

Etodolac

Fenoprofen

Flurbiprofen

Ibuprofen

Indomethacin

Meclofenamate

Mefenamic Acid

Meloxicam

Nabumetone

Naproxen

Oxaprozin

Piroxicam

Sulindac

Tolmetin

Low dose naltrexone (LDN)


ANTIBIOTICS


Find out more information about Dapsone here.


TOPICAL ANTIBIOTIC CREAMS


Topical antibiotic creams should be used with caution, and if prescribed, used in moderation. Please click here to read more about The Detriment & Overuse of Antibacterial Products.


BIOLOGICS FOR MODERATE-TO-SEVERE HS


At this time Humira is the only FDA-approved biologic for hidradenitis, anything else would be prescribed as 'off-label'. Remicade is another biologic, which is typically second in line if Humira doesn't work or if Humira stops working.


Below is a list of other biologics or biosimilars that can be discussed with your doctor should Humira or Remicade not work for you. There may be biologics or biosimilars available not listed below, please discuss with your doctor.


Abatacept (Orencia)

Anakinra (Kineret)

Certolizumab (Cimzia)

Etanercept (Enbrel)

Golimumab (Simponi)

Ixekizumab (Taltz)

Natalizumab (Tysabri)

Rituximab (Rituxan)

Secukinumab (Cosentyx)

Tocilizumab (Actemra)

Ustekinumab (Stelara)

Vedolizumab (Entyvio)

Basiliximab (Simulect)

Daclizumab (Zinbryta)

Tildrakizumab-asmn (llumya) biosimilar toTildrakizumab

Adalimumab-atto (Amjevita) Biosimilar

Infliximab-dyyb (Inflectra) Biosimilar to Remicade

Etanercept-szzs (Erelzi) Biosimilar to Etanercept

Etanercept-ykro (Eticovo) Biosimilar to Enbrel


Related Article: Biologics & What to Expect.


The two options below should be used as a last resort as they are very potent and should be considered only if your HS is severe and you have exhausted all other treatments, including biologics. These options are used in conjunction with a biologic so be sure to discuss this with your physician.


Cyclosporine

Methotrexate


Please note if you are on a biologic treatment, all of the above options above could potentially be added to your biologic treatment; always discuss all options with your physician for your personal case of HS.


OFF LABEL PRESCRIPTIONS


If your HS is not hormone-related you can consider the following, however, we advise you to discuss with your physician as these can make your HS worse if hormones are not a trigger/issue for you.

  • Spironolactone

  • Metformin

  • Hydroxychloroquine is an anti-malaria drug, also used as an alternative to steroids, and can be prescribed off label for hidradenitis.

Related article: Hormones as a Trigger


PRESCRIPTION RETINOL CREAMS


Hidradenitis is not acne; these types of creams can cause irritation and are not recommended for daily use.

  • Tretinoin (Retin-A, generic)

  • Tazarotene (Avage, Tazorac)

  • Adapalene (Differin)

PRESCRIPTION STEROID CREAMS


These types of creams and ointment are most beneficial for their anti-inflammatory properties.


Clobetasol propionate 0.05% (Temovate)

Halobetasol propionate 0.05% (Ultravate cream, ointment, lotion)

Diflorasone diacetate 0.05% (Psorcon ointment)

Betamethasone dipropionate 0.25% (Diprolene ointment, gel)


Topical Steroid Class II - considered highly potent:

Fluocinonide 0.05% (Lidex cream, gel, ointment, solution)

Halcinonide 0.1% (Halog cream, ointment, solution)

Amcinonide 0.1% (Cyclocort ointment)

Desoximetasone 0.25% (Topicort cream, ointment)


Topical Steroid Class III - considered potent:

Amcinonide 0.1% (Cyclocort cream, lotion)

Mometasone furoate 0.1% (Elocon ointment)

Fluticasone propionate 0.005% (Cutivate ointment)

Betamethasone dipropionate 0.05% (Betanate cream)

Triamcinolone acetonide 0.5% (Kenalog cream, ointment)


Topical Steroid Class IV - moderately potent:

Fluocinolone acetonide 0.025% (Synalar cream, ointment)

Flurandrenolide 0.05% (Cordran cream, ointment, lotion)

Triamcinolone acetonide 0.1% (Triderm cream, ointment, lotion)

Mometasone furoate 0.1% (Elocon cream, lotion, solution)

Fluticasone propionate 0.05% (Cutivate cream)


Topical Steroid Class V - somewhat potent:

Hydrocortisone valerate 0.2% (Westcort cream, ointment)

Hydrocortisone butyrate 0.1% (Locoid ointment)

Prednicarbate 0.1% (Dermatop cream, ointment)

Hydrocortisone probutate 0.1% (Pandel cream)


Topical Steroid Class VI - considered mild:

Desonide 0.05% (LoKara lotion)

Desonate gel, Desowen cream, ointment)

Fluocinolone acetonide 0.025% (Synalar cream, solution, shampoo)

Hydrocortisone butyrate 0.1% (Locoid cream, lotion, solution)


Topical Steroid Class VII - considered least potent:

Hydrocortisone 2.5% (Hytone cream/lotion)

Hydrocortisone 1% (Many over-the-counter brands of creams, ointments, lotions)

Hydrocortisone acetate 0.5% and 1% (Anusol-HC)

Proctocream-HC, Proctosol HC cream)


Steroid free creams:

  • Eucrisa

  • Elidel

  • Dovonex

  • Taclonex

  • Tazorec

  • Vectical

Topical antibiotic creams should be avoided, and if prescribed, please use in moderation. Please click here to read more about The Detriment & Overuse of Antibacterial Products.

Gladskin: If you have staphylococcus aureus, which can happen with HS and with some people chronically, Gladskin may help.  This product works if staphylococcus aureus is present. It can be purchased over-the-counter or online. Prior to using this product you should get confirmation from your doctor that staphylococcus is present or it may not work.


Additional resources for treatment set forth by Hidradenitis Suppurativa Decision Aid by Windsor Clinical Research Inc. can be found here.


ADDITIONAL RELEVANT ARTICLES/TREATMENT OPTIONS:



ANTIBIOTIC INFORMATION


If your doctor is prescribing antibiotics please review the information below in order to make the best decision for yourself and your personal HS.



Learn more about the use of antibiotics in HS in this interview with Dr. Vivian Shi.


ACCUTANE


If your doctor is prescribing Accutane please review the information below in order to make the best decision for yourself and your personal HS.



These are typical treatment suggestions for HS, we do not promote or endorse any pharmaceutical drugs.


Content on this site is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.


If you think you may have a medical emergency, call your doctor, go to the emergency department, or call 911 US or 999 UK immediately. A list of all emergency numbers, by country, can be found here.



Written by Denise Panter-Fixsen

Edited by Brindley Kons


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