Hidradenitis Suppurativa (HS)

Noah Scheinfeld has helped and treated over 400 patients with Hidradenitis suppurativa (HS) in the last 4 years. He has conducted major clinical trials, been published, and lectures widely on HS. Hidradenitis suppurativa (HS) is a poorly understood inflammatory skin disease. Hidradenitis suppurativa is a disease of the hair follicle. It leads to a breakdown of the follicle and scarring of skin as follicles are closed (occluded) and inflammatory substances lead to scarring under the skin. Dr. Scheinfeld\'s most recent publication includes his extensive paper in the Dermatology Online Journal dated April 2013. His practical review of medical treatments is based on over 350 hidradenitis patients.

To read the full publication, click here.

HS Is Broadly Divided Into Three Stages
(Hurley Staging)

Stage 1 - solitary or multiple, isolated abscess formation without scarring or sinus tracts
Stage 2 - recurrent abscesses, single or multiple widely separated with sinus tract formation
Stage 3 - diffuse or broad effect, with multiple interconnected sinus tracts & abscesses.

Hidradentitis Suppurativa Is:

• Not a disease of the aprocrine sweat duct
• Usually in axilla, buttocks and groin
• Not a disease caused by a bacterial infection
• Not a disease of poor hygiene
• Not a disease caused by obesity
• Worsened by the skin friction of obesity
• The mechanism of therapies is not established
• Hygiene itself does not itself effect course of HS
• HS needs a doctor who understands HS pain control

First Line Treatments

• Topical Clindamycin as gel or lotion-some data exists
• Topical Dapsone (Aczone®)-possible based on data that oral Dapsone helps HS
• Oral Tetracycline equal to topical Clindamycin

Second Line Treatments

1. Combinations of Oral Rifampin 300mg and Clindamycin 300mg - (This therapeutic regime is backed by strong clinical evidence)
2. Rifampin 300mg and Minocycline 100mg BID or
   Rifampin 300mg and Solodyn (time released Minocycline dosed between 55-135mg) once a day
3. Incision and drainage/excision of HS related cysts and abscesses
4. Injections of Intralesional Kenalog (cortisone) low dose

Third Line Treatments

1. Adalimumab 40mg - 80 mg weeking by subcutaneous (doses higher than those for psoriasis)
2. Infliximab 5-10mg/kg IV (doses higher than that for psoriasis)
3. 1064nm hair laser in combination with topical and/or oral therapies - this long pulsed laser is need to reach the base of the follicle, the center of HS's activity - Dr Scheinfeld has a 1064nm laser in the office.
   Dr Scheinfeld is a specialist and pioneer in HS laser medicine.
4. Oral Dapsone and Soriatane
5. Wide surgical excision of tissue involved with HS
6. Pain control done in conjunction with a trained pain controlled physician