Zehn Skin and Health

New to Hidradenititis Suppurativa (HS)?

Start with this short introduction and review

Topical treatments are a cornerstone in the management of mild hidradenitis suppurativa (HS) and are frequently used as adjunctive therapy in more severe cases. Applied directly to the skin, these treatments aim to reduce inflammation, combat bacterial infections, and promote healing.

Common Topical Therapies

• Topical Antibiotics:
  • Clindamycin is one of the most commonly prescribed topical antibiotic for HS. It works primarily by reducing inflammation and controlling bacterial colonization, although HS is not primarily considered a bacterial infection. Topical clindamycin is often effective in managing mild flare-ups and can be used for longer-term maintenance therapy in some patients. Research has shown that topical clindamycin can significantly reduce the severity of HS lesions and improve patient-reported outcomes.
• Topical Antiseptics:
  • Antiseptics like chlorhexidine wash can be beneficial in reducing bacterial load on the skin surface, helping to prevent secondary infections and manage odor associated with HS lesions. Regular washing with antiseptic cleansers can be part of a good hygiene regimen for HS management.
  • Zinc Pyrithione, classically used as an anti-fungal, can be employed for HS due to its additional anti-inflammatory, antibacterial, and anti-androgenic mechanisms. Patients with hidradenitis suppurativa can use shampoo containing pyrithione zinc 1% to wash all hair-bearing areas, which are most prone to colonization by bacteria and yeast, in place of soaps or other antiseptic washes.
• Topical Resorcinol:
  • Resorcinol is a peeling agent that can help to open clogged hair follicles and reduce inflammation. It is available in various concentrations and formulations. Compounded resorcinol 15% cream has shown promise in clinical studies for reducing pain and lesion severity in HS. It is thought to work by promoting skin shedding and reducing keratin buildup in follicles.

Considerations for Topical Treatment

• Mild HS and Adjunctive Therapy:
  • Topical treatments are generally most effective for Hurley Stage I HS and as part of combination therapy for more advanced stages. They are often insufficient as monotherapy for moderate to severe HS.
• Combination Approaches:
  • Topical treatments are frequently used in combination with oral medications, biologics, and surgical interventions to achieve optimal disease control.
• Long-Term Management:
  • Topical antibiotics like clindamycin may be used for maintenance therapy to prevent or reduce the frequency of flare-ups in some individuals. However, long-term antibiotic use carries a risk of bacterial resistance, so judicious use is important.
• Proper Application and Hygiene:
  • For topical treatments to be effective, consistent and proper application is crucial. This includes cleansing the affected area gently before application and following the prescribed application frequency. Maintaining good hygiene practices, such as gentle cleansing and keeping the skin dry, enhances the effectiveness of topical therapies.
• Limitations:
  • Topical treatments have limitations in their ability to penetrate deep into the skin and address the underlying inflammatory processes in HS. They are generally less effective for deep nodules, tunnels, and widespread disease.

While topical treatments alone may not be sufficient to manage all cases of HS, they remain a valuable tool, particularly for mild disease and as part of a comprehensive treatment strategy. Ongoing research promises to expand the arsenal of effective topical therapies for HS in the future.

References

Hidradenitis suppurativa – Diagnosis and treatment – Mayo Clinic, accessed February 8, 2025, https://www.mayoclinic.org/diseases-conditions/hidradenitis-suppurativa/diagnosis-treatment/drc-20352311

A concise clinician’s guide to therapy for hidradenitis suppurativa – PMC, accessed February 8, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC7105662/

Topical clindamycin for hidradenitis suppurativa: systematic review and meta-analysis – PubMed, accessed February 10, 2025, https://pubmed.ncbi.nlm.nih.gov/31408121/

Resorcinol 15% cream for the treatment of hidradenitis suppurativa: A randomized, double-blind, vehicle-controlled study – PubMed, accessed February 10, 2025, https://pubmed.ncbi.nlm.nih.gov/34418204/

Hidradenitis Suppurativa (Acne Inversa): Symptoms & Treatments – Cleveland Clinic, accessed February 8, 2025, https://my.clevelandclinic.org/health/diseases/17716-hidradenitis-suppurativa