Hidradenitis Suppurativa treatment by Ray Sahelian, M.D.
Feb 24 2014

Hidradenitis is a chronic disease of the apocrine glands (a form of sweat gland found on certain parts of the body). Patients with hidradenitis develop plugging or clogging of their apocrine glands leading to pus formation of the underarms (axilla) and groin/inner thigh areas. 

Similar to acne
In women hidradenitis suppurativa can also occur under the breasts. It is similar to acne, which is also a disease of the sebaceous glands. Hidradenitis is more common in people who have had acne.
   Female patients presenting with hidradenitis suppurativa should be evaluated for underlying PCOS and insulin resistance.

Natural treatment for hidradenitis supparativa
Could eating more fish and vegetables while reducing junk food help? Perhaps.

Hidradenitis suppurativa and zinc: a new therapeutic approach. A pilot study.
Dermatology. 2007. Department of Dermatology, CHU Hotel-Dieu, Nantes, France.
Researchers in France performed a pilot study on 22 Hidradenitis suppurativa patients, mainly from grade I or II in Hurley's classification. All included patients had previously been prescribed a treatment (antibiotic, isotretinoin, surgery or anti-androgens), which was inefficient. They were then treated with 90 mg of zinc gluconate per day (15 mg zinc per Rubozinc capsule). There was a clinical response in all patients, with 8 complete remissions (CR) and 14 partial remissions (PR). When CR was obtained, the treatment was progressively decreased (average of 3.5 capsules/day); 4/22 patients experienced side-effects, mainly gastro-intestinal. Zinc salts could provide a new therapeutic alternative for the treatment of hidradenitis suppurativa.

Q. I just read about the study with Rubozinc for patients who suffer from hydroadenite suppurative and I would love to know where to buy it. I have hidradenitis suppurativa and it 's still very light however I can't let it take over my body so I am looking for something like this to take and put me away of antibiotics, since they don't work anymore....the bumps keep coming back. |
   A. We don't know where Rubozinc is sold, but it is the same as zinc gluconate.

Q. I recently discovered your website, and I am extremely happy that you took the time and effort to list information on possible cures for hidradenitis suppurativa. My mother has been suffering from this painful disease for over 3 years now. We have tried everything from antibiotics to numerous surgical procedures which seemed to make everything worst. After I read about zinc gluconate, I went down to the nearest CVS to purchase it. Instead I found Nature's Bounty chelated zinc 50Mg. Will this work as good as the zinc gluconate, if she were to take 2 caplets daily?
   A. I suspect the chelated zinc would be similar to zinc gluconate in its effectiveness, but I am not 100 percent sure since I have not seen studies using chelated zinc for hidradenitis suppurativa.

Pharmaceutical medication use
Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease. Since current treatments are unsatisfactory for many patients, there is a high need for effective drugs for this debilitating disease. Recent pathogenic insights suggest inflammasome activation and IL-1β production are important in HS. Colchicine is efficacious in the IL-1β- and inflammasome-mediated diseases gout, familial Mediterranean fever and Behçet's disease, but studies have not shown in to be an effective drug in HS.

JAMA Dermatol. 2013. Finasteride for the treatment of hidradenitis suppurativa in children and adolescents.

Br J Dermatol. 2013. Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. HS is a difficult disease to treat. Although the pathogenesis of this inflammatory skin disease is largely unknown, the important role of the immune system has been demonstrated in both experimental and clinical studies. Clinicians are therefore increasingly prescribing systemic treatments with immunosuppressive agents, but the more traditionally used systemic retinoids, especially isotretinoin, also remain relatively common therapies. In order to provide an overview of all currently available systemic immunosuppressive agents and retinoids for the treatment of HS, a systematic search was performed using the Medline and Embase databases. All published papers concerning systemic retinoids or immunosuppressive treatments for HS in adults were included. The primary endpoints were the percentages of significant responders, moderate responders and nonresponders. Other endpoints were the relapse rate and adverse events. In total 87 papers were included, comprising 518 patients with HS who were treated with systemic retinoids, biological agents or another immunosuppressive agents, including colchicine, ciclosporin, dapsone or methotrexate. The highest response rates were observed with infliximab, adalimumab and acitretin. Overall, the quality of evidence was low and differed between the agents, making direct comparisons difficult. However, based on the amount of evidence, infliximab and adalimumab were the most effective agents. Acitretin was also effective in HS, although the quality of the evidence was low. The therapeutic effect of isotretinoin is questionable.

The use of Dapsone
Hidradenitis suppurativa treated with dapsone: A case series of five patients.
J Dermatolog Treat. 2006. Department of Dermatology, University Hospital Birmingham NHS Trust, Selly Oak Hospital, Birmingham, UK.
To evaluate the efficacy of dapsone in the treatment of hidradenitis suppurativa refractory to therapy with oral antibiotics and isotretinoin. A retrospective review was performed of five patients treated with dapsone between 2002 and 2005. Clinical improvement and dapsone side events were recorded by the physician. Improvement was noted in all five patients within 4-12 weeks at doses ranging between 25 and 150 mg/day. All patients required maintenance therapy with dapsone at doses between 50 and 150 mg/day to sustain their hidradenitis suppurativa control. Patient-reported hidradenitis suppurativa symptoms improved in all cases after dapsone initiation, supporting physician observed clinical improvement. Hidradenitis suppurativa treatment was well tolerated in all patients with no significant dapsone side effects noted. The median follow-up period was 24 months. Conclusion: Dapsone appears to be an effective and safe alternative treatment option for hidradenitis suppurativa and may be particularly useful for women in the reproductive age group.