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  • The Review Course in Family Medicine

Hidradenitis Suppurativa: Practical Guidelines for Managing Patients

Here are the top takeaways when managing patients with Hidradenitis Suppurativa (HS):

1. Diagnose HS based on 3 criteria:

  • lesion morphology

  • distribution in areas with many apocrine glands (axilla, groin)

  • chronicity/ recurrence of lesions

2. Assess for severity using the Hurley staging system, which categorizes the disease into mild, moderate, and severe

3. Screen for associated comorbidities especially IBD, but also for metabolic syndrome, PCOS and diabetes

4. Counsel patients on 5 key lifestyle modifications:

  • Smoking cessation improves disease severity

  • Encourage low-friction clothing and low sweating exercises like swimming or yoga

  • Promote low glycemic index foods and low dairy diets

  • Supplement with zinc, copper, and vitamin D to reduce disease burden

  • Reduce stress

5. Monitor patients as they are at increased risk for depression and anxiety

6. Watch lesions for progression to Squamous Cell Carcinoma (SCC), especially in patients

with vulvar, perineal, and/or perianal disease

7. Base your management of flares on severity:

  • Mild: Stay topical – skin cleansers with Resorcinol, benzoyl peroxide, clindamycin and retinoids

  • Moderate: add oral antibiotics with tetracycline, clindamycin and rifampin

  • Severe: Consider IV antibiotics. Severe case may require biologic therapy and de-roofing surgery.

8. For all patients and ongoing management, you can offer:

  • Laser hair removal

  • Anti-androgenic therapy (metformin, OCP, finasteride, spironolactone)

  • Intralesional steroid/botulism injections


Johnston LA, Alhusayen R, Bourcier M. Practical guidelines for managing patients with

hidradenitis suppurativa: an update. J Cutan Med Surg 2022; published online August 24, 2022.

(accessed September 6, 2022)



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