Hidradenitis suppurativa

Mild disease – Intermittent small numbers of inflammatory nodules and/or abscesses. Minimal scarring and no tunnels.

Doxycycline (or lymecycline if intolerant of doxycycline) for three months.

Moderate to severe disease – more frequent or constant nodules and/or abscesses with scarring +/- tunnels.

Refer to Dermatology. This pathway provides treatment options while awaiting secondary care review.

Doxycycline (or lymecycline if intolerant of doxycycline) for three months.

If previous treatment ineffective, consider replacing with oral clindamycin and rifampicin for 3 months while awaiting Dermatology review.

Additional options that may be considered in addition to previous treatments.

For females if having cyclical flares.

Acute flares (e.g. acutely inflamed abscess) regardless of disease severity.

If penicillin allergic, consider clarithromycin or co-trimoxazole.

Anti-TNF – adalimumab. Adalimumab should be prescribed by brand name in line with local guidance (where available).

IL-17A inhibitor – secukinumab.

IL-17A and IL-17F inhibitor – bimekizumab.

Anti-TNF – infliximab.

Anti-TNF – adalimumab. Adalimumab should be prescribed by brand name in line with local guidance (where available).