Medical management of Hidradenitis Suppurativa (HS) is difficult and involves the use of multiple drugs. Not all individuals respond to one class of drugs and some require multiple combination of drugs.
The typical medications used to tread HS include:
Topical antibiotics: There are numerous topical antibiotics available to treat HS. These are the same antibiotics used to treat acne. The usual antibiotics include clindamycin, erythromycin and polysporin. They usually do not do much for the disorder.
Acids: There are also topical peeling agents like benzyl peroxide which are frequently used to treat HS. They seldom work.
Antibiotics: When the cysts are inflamed, red and tender, antibiotics are usually administered. In general antibiotics are effective during the early stage of the disease. In many cases of HS, antibiotics are administered for more than 3-6 months. In all cases a combination of antibiotics is preferred to avoid development of drug resistance.
Oral contraceptives: It is widely believed that there is an excess of the male sex hormone, testosterone which may play a role in triggering HS. Thus, some women are administered an oral contraceptive for 9-12 months. A majority of women do show a positive response to hormonal therapy.
Spironolactone: This drug has anti androgenic properties and is often used to treat severe acne and HS. It does work in a number of cases. A disturbing side effect for the males is the growth of breasts (gynecomastia). The breast growth resolves once the drug is stopped.
Retinoids: Retinoids have shown benefit in a number of individuals with HS. However, these drugs can have harmful effects on the fetus and their use in young females is of concern. Any young female who takes Retinoids, must avoid getting pregnant for at least 3 years after discontinuing the drug.
Oral steroids: Both oral and intralesional corticosteroids have been used to treat HS. They do decrease the inflammatory response and redness but are not curative. Oral corticosteroids are generally given for a short duration because of their severe side effects.
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