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Treatment of hidradenitis suppurativa (acne inversa)

Lynette J Margesson, MD, FRCPC, FAAD
F William Danby, MD, FRCPC, FAAD
Section Editors
Russell S Berman, MD
Robert P Dellavalle, MD, PhD, MSPH
Mark V Dahl, MD
Deputy Editors
Abena O Ofori, MD
Kathryn A Collins, MD, PhD, FACS


Hidradenitis suppurativa/acne inversa (HS/AI) is a chronic follicular occlusive disease that affects the folliculopilosebaceous unit (FPSU), mainly but not exclusively in intertriginous axillary, groin, perianal, perineal, genital, and inframammary skin. The clinical course is highly variable, ranging from relatively mild cases characterized by the recurrent appearance of papules, pustules, and a few inflammatory nodules to severe cases demonstrating deep fluctuant abscesses, draining sinuses, and severe band-like scars.

The management and prognosis of HS/AI will be reviewed here. The pathogenesis, clinical features, and diagnosis of this disorder are discussed separately. (See "Pathogenesis, clinical features, and diagnosis of hidradenitis suppurativa (acne inversa)".)


Although HS/AI is not life threatening, the pain, odor, drainage, and disfigurement associated with this disorder regularly have deleterious effects on patient quality of life. Patients often experience feelings of sadness or depression related to the disease, and feelings of shame may contribute to self-imposed social isolation [1-4]. Because of the significant physical and emotional toll of HS/AI, patients often aggressively seek treatment, sometimes despite past diagnostic and therapeutic disappointments.

Acne vulgaris, the less serious clinical variant of HS/AI, has been strongly associated with the "Western diet" [5], a dairy-laden and calorie-dense food style that is also the basis of the metabolic syndrome, a constellation of risk factors (ie, obesity, dyslipidemia, hyperglycemia, hypertension) for diabetes and cardiovascular disease. We propose that the same contributory dietary factors operating in acne vulgaris play an identical role in the genesis of both HS/AI and metabolic syndrome, though each may exist independently. Clinicians managing diets in patients with HS/AI [6,7] should be aware that HS/AI patients who demonstrate an elevated body mass index often have increased risk for these comorbidities [8,9]. (See "The metabolic syndrome (insulin resistance syndrome or syndrome X)".)

Treatment goals — In the absence of successful measures for prevention and treatment of the clinical manifestations of HS/AI, the disease can remain active for many years. The treatments for HS target one or more of three major goals:


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Literature review current through: Apr 2016. | This topic last updated: Nov 24, 2015.
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