Treatment Experience in a Local Population With Hidradenitis Suppurativa

July 2014 | Volume 13 | Issue 7 | Original Article | 827 | Copyright © July 2014

John J. Kohorst,a Clinton Hagen,b Christian L. Baum MD,c Mark D. P. Davis MDc

aMayo Medical School, Mayo Clinic College of Medicine, Rochester, MN
bDivision of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
cDepartment of Dermatology, Mayo Clinic, Rochester, MN

BACKGROUND: Treatment of hidradenitis suppurativa has been studied, but treatment strategies and outcomes have not been reported for a large community-based group of patients.
OBJECTIVE: We sought to determine the treatments most commonly prescribed and the performance of all systemic and surgical treatments used in hidradenitis suppurativa patients in Olmsted County, Minnesota, treated over a 40-year period.
METHODS: A retrospective chart review was performed to evaluate hidradenitis suppurativa treatments in 376 episodes with 115 Olmsted County patients seen by a clinician at Mayo Clinic in Rochester, Minnesota, between 1968 and 2008. Treatment episode outcomes were recorded from clinical notes for the 73 treatment episodes that had a follow-up period of more than 30 days.
RESULTS: Systemic antibiotics alone were prescribed most frequently in 70.0% of episodes. Systemic antibiotics alone improved 39 of 49 treatment episodes (79.6%), including 13 episodes (26.5%) when the disease was fully cleared. All 5 of 5 episodes (100%) of surgical treatment alone improved, including 4 (80%) in which the disease was fully cleared. Surgery in combination with systemic antibiotic treatment yielded improvement in 5 episodes (71.4%), with 2 episodes (28.6%) showing complete clearance.
CONCLUSION: Systemic antibiotics were the most frequently prescribed treatment type in 115 patients over a 40-year period. Both systemic antibiotic therapy and surgical treatment are effective in disease management.

J Drugs Dermatol. 2014;13(7):827-831.


Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the hair follicle, with an estimated incidence of 0.006%.1 Inflammatory nodules form at apocrine gland–bearing sites of the axilla, groin, thigh, buttocks, and breast. The nodules can be highly painful and odorous and are often complicated by bacterial infections, draining sinuses, scarring, and fistula and stricture formation. The physical and psychologic impact of HS has been shown to worsen patient quality of life.2 Although it may not be routinely used in practice, the Hurley staging system may be used to classify the severity of disease in patients with HS.
Hidradenitis suppurativa has no definitive treatment approach. The goals of treatment are to clear inflammatory nodules and complicating lesions and to prevent recurrence. To achieve these goals, clinicians have used various treatments based on disease severity and other patient-specific considerations. For Hurley stage I disease, clinicians typically prescribe topical antibiotics, triamcinolone injections, and occasionally systemic antibiotics. In general, clinicians also encourage patients to lose weight, avoid use of deodorants, wash affected areas with antiseptic soap, and avoid irritating the lesion with tight-fitting clothing. Hurley stage II disease is commonly managed with systemic antibiotics, such as tetracyclines, macrolides, and cephalosporins, which are often switched as resistance develops. Systemic hormones with antiandrogen activity have also been used to treat Hurley stage II disease. Incision and drainage has been used for symptomatic relief of painful, fluctuant nodules in mild HS.3 Advanced Hurley stage III HS is typically managed with surgical excision, especially if scarring is evident, but in recent years, the tumor necrosis factor α inhibitor infliximab has shown efficacy in advanced HS.4
A uniform treatment approach to patients with HS is complicated by the rarity of HS, the various anecdotal treatments, and the paucity of evidence-based data management. Past studies have focused on the effectiveness of 1 or 2 particular treatments (Table 1), but an evaluation of the performance of all treatments used in a particular HS patient population would provide a valuable tool for selecting evidenced-based treatments. The aim of this study was to analyze the experience of HS management from 1968 to 2008 in Olmsted County patients treated at Mayo Clinic.


Study Criteria

This project was built on a population-based study of HS in Olmsted County, Minnesota, using the Rochester Epidemiology Project.1 The original project identified 268 patients who received a new diagnosis of HS between 1968 and 2008. For the present study, patients were included if follow-up data were available after a treatment plan was initiated.