Hidradenitis Suppurativa is defined to be a dermatological condition
that has a tendency to affect the areas that are containing the sebaceous or
sweat glands. The areas most commonly involved are the breasts, axillae, groin,
buttocks and thighs. Sometimes, it may also involve the anal region.
Hidradenitis Suppurativa can be easily diagnosed by a dermatologist and Hidradenitis treatment usually focuses
on how severe the condition is. There are four main options that can
individually or cumulatively applied on the treatment of Hidradenitis
Suppurativa: Lifestyle, Pharmacotherapy, Radiotherapy and Surgery.
1.
Lifestyle:
It has been seen that diet plays a major role in the treatment of
Hidradenitis Suppurativa.
Foods that are extremely high in refined carbohydrates and fried foods
have been seen to play a role in the development of this condition. This
explains why this condition is commonly seen amongst overweight and obese
patients.
Warm compresses are helpful when applied to the affected area and best
results are seen when they are applied with distilled vinegar water. This is
commonly known as hydrotherapy. Alternatively, pain reduction can be done by
icing the inflamed area once/twice daily.
2.
Pharmacotherapy:
Antibiotics are of particular use in the treatment of Hidradenitis
Suppurativa because they aim to reduce inflammation and infection both. The
combination therapy of clindamycin and rifampicin has been considered to be the
most effective till date. The topical application of clindamycin is also
considered to be really useful. This therapy is used for a course of 3 months.
Alternative antibiotics that can be considered are tetracyclines.
Vitamin A therapy is used because it promotes the growth of new skin.
Similar mechanism of action is seen in Zinc also therefore it is also usually
prescribed. Additionally, corticosteroid injections are considered to be
extremely useful for the localized diseases because of their superior
anti-inflammatory effects. Anti-TNF alpha inhibitors are amongst the recently
available drugs which are given in injectable forms and are also efficient in
waning off inflammation.
For cleansing the skin, usage of antibiotic soap and chlorhexidine is
recommended. Also, turmeric powder can either be used topically or capsules are
also shown to be effective. In the hidradenitis
treatment principles, it must also be known that a keratolytic agent is
also recommended as it targets the lesion site and heals it. Topical resorcinol
is an example of keratolytic agent. Nowadays, Anti-androgen therapies in the
form of estradiol and cryproterone acetate have proven to be useful. However,
randomized controlled trials for these are still underway.
3.
Radiotherapy:
For Hidradenitis treatment, electron
beam radiotherapy has been shown to be of promising effect. Commonly being used
in Europe, it is still a resilient form of treatment in United States because
oncologists resist treating patients with electron beam radiotherapy unless
they have a cancerous disease going on.
4.
Surgical
treatment:
After all the above mentioned treatments, there are still some
unfortunate patients who have Hidradenitis Suppurativa which is resistant to
all forms of treatment. In this situation, it is advised for a wide surgical
excision of the affected area. Since wounds in this area are unable to heal by
secondary intention, usually, skin flap from the patient’s own body part is
grafted on the surgically excised area.
Usually, Hidradenitis responds to medical therapy and rarely does any
need come for radio/surgical therapy. The main treatment still resides in
dietary modification and if a good diet control is achieved, the lesions can
themselves resolve away and further lesions can be prevented from formation.
Also, preventing the triggering factors (obesity, tight clothing, shaving
affected area, oral contraceptives and hot/humid climates) can themselves bring
a lot of change to this disturbing dermatological condition.
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