Treatment Modality for Preventing Recurrence of Hidradenitis Suppurativa: Surgery Versus Long-term Antibiotics

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Hidradenitis suppurativa is an inflammatory disease affecting up to 4% of the general population. Morbidity associated with hidradenitis suppurativa can have extremely deleterious effects on the patients involved including scarring, septicemia, pain, and a decreased quality of life. Diagnosis is based solely on clinical presentation with a history of nodules, sinuses, or abscesses for longer than 6 months. Although treatment options for hidradenitis suppurativa vary, evidence supports treatment with antibiotics or surgery. Current treatment options for mild hidradenitis suppurativa include topical clindamycin and/or the combination therapy of 10 weeks of oral clindamycin and rifampin. For more severe forms of the disease, different surgical approaches have been studied. Wide radical excision shows the most success with the fewest recurrences. Despite current practices, more research is needed such as large-scale randomized controlled trials to identify the most effective medication therapy regime such as antibiotic, immunologic, and hormonal agents or a combination therapy. More research is also needed on the effectiveness of surgery and should include laser surgery as an adjunctive treatment. On the basis of the results of this research, a universal clinical practice guideline could be established outlining the most effective treatment strategies for hidradenitis suppurativa.

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