Analysis of Treatment Modalities and Demographic Characteristics in Hidradenitis Suppurativa

Abstract

Introduction

Hidradenitis Suppurativa (HS) is a chronic inflammatory condition that affects 0.1% to 2% of the general population, with a higher prevalence in African Americans and females. HS can be a debilitating condition with burdensome costs. Numerous guidelines and treatment options have been developed for HS in which antibiotics have been a mainstay in reducing flares; However, there is limited quality evidence on which antibiotic regimens are most effective and maintain long-term efficacy. The purpose of this study is to analyze the use of various antibiotics in HS patients as well as the use of other topical and oral medications for the management of this disease to help optimize future treatment guidelines.

Methods

A retrospective chart review of patients diagnosed with HS from April 2023 to June 2024 was conducted at a single institution. Various patient demographics were analyzed including age, gender, race, and body mass index (BMI). Hurley Staging was used to stratify HS disease severity from stages I to III. Prescribing practices for topical therapies, oral antibiotics, isotretinoin, androgen receptor antagonists, zinc, intralesional kenalog, and immunologic treatments were also analyzed.

Results

Among 90 patients with HS, 77 (86%) were female and 13 (14%) were male with a median age of 44.5 years (range 19-73 years) and a mean BMI of 37 kg/m2. In terms of race, 71 (79%) of patients were African American, 15 (17%) were White, and 4 (4%) were not reported. 26% of patients had Hurley Stage I disease, 22% had Hurley Stage 2 disease, and 29% had Hurley Stage 3 disease, with the other patients falling in between the stages. Treatment modalities included topical benzoyl peroxide (BPO) washes or other antiseptic washes in 88% of patients and topical clindamycin in 78% of patients, respectively. In terms of oral medications, antibiotics were widely prescribed to all patients at a rate of 76% overall. The most commonly prescribed oral antibiotic was doxycycline at 74%, followed by clindamycin at 20%, rifampin at 18%, bactrim at 4%, and metronidazole, augmentin, and moxifloxacin at 3% each, respectively. The mean duration of antibiotic therapy was 10 months (SD: 17 months). Other oral medication treatments, androgen receptor antagonists such as spironolactone and finasteride used in 40% of patients, and oral zinc prescribed to 32% of patients.

Intralesional kenalog injections were administered in 35% of cases and deroofing surgery was performed for 7% of patients. Ultimately, 44/90 (49%) of patients required treatment with immunomodulating or biologic therapies to reach their maintenance HS treatment goal.

Conclusion

The findings of this study indicate that along with topical antiseptic washes and clindamycin, antibiotics are a mainstay for treatment of HS. At this institution, doxycycline was the most commonly prescribed antibiotic for HS management. Further research will need to be conducted to analyze the use of specific antibiotics for specific stages of disease, and to analyze differences of antibiotic use for certain demographic factors, including gender and race to see if this will reduce the need to escalate to biologic therapies.