This handout is for hidradenitis suppurativa (acne inversa). Your care team identified this based on: recurrent painful inflammatory nodules / abscesses in apocrine-bearing intertriginous sites (axillae, groin, inframammary, perianal/genital) (us/canadian hs foundations 2019 part i pmid 30872156).
Other reasons your team may use this plan: draining sinus tracts / tunnels + bridged scarring + "tombstone" double comedones — established hs morphology (european s2k 2024 pmid 39699926); chronicity / recurrence (≥2 episodes in 6 months in typical sites) — the diagnostic third element distinguishing hs from a one-off abscess (us/canadian hs foundations 2019 part i pmid 30872156); obesity / smoking / metabolic syndrome / ibd / spondyloarthropathy / pcos / depression — the hs systemic-inflammatory comorbidity cluster prompting active screening (us/canadian hs foundations 2019 part i pmid 30872156).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| smoking_cessation | — | — | — | US/Canadian HS Foundations 2019 Part I (PMID 30872156) + European S2k 2024 (PMID 39699926) — tobacco is a dominant modifiable driver; cessation is foundational at every step and improves treatment response. |
| weight_optimisation_and_metabolic_risk_management | — | — | — | US/Canadian HS Foundations 2019 Part I (PMID 30872156) — obesity/metabolic load aggravates HS; weight reduction (incl. bariatric referral when indicated) reduces severity. |
| friction_reduction_wound_care_and_pain_management | — | — | — | US/Canadian HS Foundations 2019 Part I (PMID 30872156) — loose clothing/friction reduction, absorbent dressings/wound care, and structured pain management are core, every-step supportive measures. |
| clindamycin (topical) | 1% solution/gel | topical | BID for ~12 wk | US/Canadian HS Foundations 2019 Part II (PMID 30872149) + European S2k 2024 (PMID 39699926) — topical clindamycin is the first-line topical for mild/localised HS; the only RCT-supported topical antibiotic. |
| chlorhexidine | 4% wash | topical | daily antiseptic wash | US/Canadian HS Foundations 2019 Part II (PMID 30872149) — antiseptic washes are a low-risk adjunct reducing bacterial load/flare frequency. |
| benzoyl peroxide | 4–10% wash | topical | daily antiseptic wash | US/Canadian HS Foundations 2019 Part II (PMID 30872149) — benzoyl peroxide wash is an alternative antiseptic adjunct for mild HS. |
| resorcinol | 15% cream | topical | BID / PRN to active nodules | US/Canadian HS Foundations 2019 Part II (PMID 30872149) — topical resorcinol reduces pain/duration of recurrent focal nodules; useful patient-applied flare tool. |
Plan: Hidradenitis suppurativa — foundational non-pharm + Hurley/IHS4 severity-driven ladder (US/Canadian HS Foundations 2019 + European S2k 2024)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: lifelong smoking-cessation + weight-management reinforcement, friction/wound-care self-management, written flare action plan, biologic maintenance with continued TB/infection vigilance, periodic comorbidity surveillance (metabolic syndrome, IBD, spondyloarthropathy, PCOS, depression/suicidality), antibiotic-stewardship review, and SCC surveillance of long-standing chronic perianal/buttock sites. Multidisciplinary continuity; reconsider surgery for residual tract burden once inflammation controlled.
Guideline: US/Canadian HS Foundations 2019 North American clinical management guidelines — Part I diagnosis/evaluation/procedural (Alikhan et al, JAAD; PMID 30872156) + Part II topical/intralesional/systemic medical (Alikhan et al, JAAD; PMID 30872149) + European S2k guidelines for HS/acne inversa Part 2: Treatment (Zouboulis et al, JEADV 2024; PMID 39699926 — IHS4-driven medical ladder + Hurley-driven surgery) + pivotal biologic RCTs PIONEER I/II adalimumab (Kimball et al, NEJM 2016; PMID 27518661), SUNSHINE/SUNRISE secukinumab (Kimball et al, Lancet 2023; PMID 36746171), BE HEARD I/II bimekizumab (Kimball et al, Lancet 2024; PMID 38795716)