- Recurrent abscesses and boils with sinus formation in flexural apocrine sweat gland bearing skin e.g. axillae, groin, perineum, inframammary areas, inguinal region and the suprapubic region
- May present as recurring ‘ingrowing hairs’, abscesses or occasionally pilonidal sinuses
- Open double-headed comedones
- Painful firm papules and nodules
- Pustules, fluctuant pseudocysts and abscesses
- Draining sinuses linking inflammatory lesions
- Hypertrophic and atrophic scars
The Hurley system, the most widely used assessment tool, describes three clinical stages:
Record Hurley stage at area worst affected.
Early referral to Dermatologist is key to access systemic therapy for moderate to severe cases.
General measures for treating Hidradenitis Suppurativa include:
- Weight loss in an obese patient is essential
- Smoking cessation
- Loose fitting clothing
- Absorbent dressings if discharging nodules present
- Management of anxiety and depression
Hurley stage 1 or mild Hurley stage II disease
|1st choice options for Adults and Children
|Clindamycin (Dalacin T®) lotion 10mg/ml
|Apply thinly to affected areas every 12 hours
|Assess response after 6 months
|Apply after thorough cleansing. Counsel patient that this product may cause stinging
Oral Treatment indicated for papules or nodules
|1st choice options for adults
408mg every 24 hours
Assess response after 12 weeks. Consider treatment break to assess need for ongoing therapy and to limit risk of antimicrobial resistance.
Avoid in Pregnancy and consider contraception in women of child bearing age.
Each capsule contains 408mg Lymecycline equivalent to 300mg of Tetracycline base (Tetralysal® 300mg).
Please Note:Minocycline may be initiated in secondary care and if transcribing prescription advise patient of and monitor for abnormal LFT’s, irreversible cutaneous pigmentation and reversible drug induced lupus. Minocycline can cause a blue-grey discolouration of inflamed skin.
Hurley Stage III: Severe Inflammatory flares
Rifampicin 300mg every 12 hours and clindamycin 300mg every 12 hours may be initiated in secondary care by a Consultant Dermatologist and if transcribing prescription please note that rifampicin is an enzyme inducer, refer to interaction table. and refer to HPRA. Please note that rifampicin is never prescribed as monotherapy.
Treatment of acute abscesses
|1st choice option for adults
|500mg every 6 hours
|Should be taken at least 1 hour before or 2 hours after meals.
|2nd choice option
|500mg every 12 hours
|Children: 1st Choice Option
|See Flucloxacillin dosing for children
Adalimumab (Humira) is licensed for the treatment of severe Hidradenitis suppurativa initiated by a Consultant Dermatologist. The regimen is a higher loading dose and more frequent maintenance dose than in psoriasis.
Reviewed January 2022