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