Does anyone suffer from hidradentitis suppurativa?

Question

If so, what is it that you have been doing to contol your "outbreaks"? I have been using an acne cleanser that contains salicylic acid that seems to help, but it is harsh on my skin in my affected areas. Just wondering what other HS suffers do.

Answer 1

SUMMARY AND RECOMMENDATIONS — We try to adhere to the following principles for the diagnosis and treatment of HS:

Have a high index of suspicion for the disease in women with recurrent boils in apocrine areas after puberty, despite antibiotic therapy. Premenstrual exacerbation of lesions is also typical of HS.
Educate the patient about the course of HS and encourage consistent follow-up to provide early treatment of lesions. The patient should understand that there are two goals: management of existing lesions and prevention of new ones.
Improve the local environment by reducing friction from clothing, heat, and sweating. We emphasize the importance of loose underwear since mechanical friction appears to exacerbate the disease. Regular use of antiperspirants is recommended, although application of these agents to inflamed skin can be irritating in some patients. Weight reduction can be very helpful.
For women with a few isolated lesions without sinus tracts and ongoing formation of new lesions, we prescribe topical clindamycin (1 percent lotion twice per day for three months), spironolactone (25 mg daily for three months), and the oral contraceptive pill ethinyl estradiol drospirenone (Yasmin) because drospirenone has antiandrogenic effects. We avoid depot medroxyprogesterone acetate, progestin-only pills and pills with a highly androgenic progestin. We inject isolated persistent lesions with triamcinolone.
For women with multiple lesions and sinus tracts, surgical excision is the treatment of choice. The sinus tracts should be unroofed and debrided. Limited "de-bulking" excision is helpful to avoid the morbidity of extensive surgery, even when this leaves active disease at the margins, which can be treated medically. Although re-excisions are likely to be required with this approach, these procedures will involve smaller areas that are appropriate for primary closure with a reasonable healing time.