Table 2.

Treatment options for hidradenitis suppurativa.

Treatment	Advantages	Disadvantages
Lifestyle modification and general management Lifestyle modification44–49  Cessation of smoking  Avoid rough clothing and tight underwear, jeans, belts, bras, and collars and opt for loose cotton fabrics  Reducing body weight General management2,6,29,50–53  Pain management  Wound care  Psychological support	Valuable adjunctive options to conventional medical treatments. Useful in situations where prescription medications are unsuitable, e.g., immunosuppression or pregnancy. No side effects.	Insufficient as a solitary treatment strategy. It demands considerable time, dedication, and overcoming ingrained habits.
Topical treatment2,54  Topical clindamycin 1%  Topical resorcinol 15%  Skin cleansers	Simple to use and apply, with few systemic adverse effects, suitable for  milder forms of HS.	Local side effects like skin irritation or allergic reactions. Not suitable for widespread illness.
Intralesional therapy55–57  Steroid (triamcinolone) injections	A safe, well-tolerated, and efficient method that is known to reduce discomfort, swelling and hasten the shrinkage of fistulous tracts and abscesses.	May result in skin atrophy, telengiectasia, and hypopigmentation. The risk of glycemic decompensation in diabetic patients requires caution.
Systemic antibiotics5,58–62  Oral tetracyclines (eg. doxycycline 50-100 mg twice daily)  Oral clindamycin 300 mg twice daily plus oral rifampicin 600 mg daily for 12 weeks  Moxifloxacin (400 mg daily), rifampicin (10 mg/kg daily), and metronidazole (500 mg thrice daily) for up to 12 weeks, with discontinuation of metronidazole after 6 weeks	A widely utilized and effective treatment option, oral antibiotics offer ease of administration and convenience, particularly for treating widespread or inaccessible areas. They can also be combined synergistically with other therapies like topicals or biologics for enhanced efficacy.	Side effects include gastointestinal disturbances, and sun sensitivity associated with tetracyclines; Clostridium difficile-associated diarrhea, rash, and hepatotoxicity linked to clindamycin; orange-tinged bodily fluids resulting from rifampin use; and methemoglobinemia and cyanosis of the lips associated with dapsone. Risk of leading to bacterial resistance
Biologics63–68  Adalimumab on Week 0 (160 mg S.C.), Week 2 (80 mg S.C.), and every week (40 mg S.C) for 12 weeks followed by assessment  Secukinumab (300 mg weekly for 5 weeks, then every 4 weeks.)	Biologics specifically target the underlying inflammatory pathways involved in HS, offering high efficacy, long-term disease control, and improved overall well-being.	It requires careful monitoring due to infection, drug interaction risks, and the potential for malignancy, like lymphomas. Secukinumab has been associated with Crohn's disease.
Surgery37,69–73  Incision and Drainage  Deroofing  Excision  Lasers	Offers significant advantages in severe cases of HS, particularly for addressing recurrent or persistent abscesses.	May lead to scarring, infection, bleeding, pain, wound dehiscence, and recurrence

HS, hidradenitis suppurativa.