Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent, painful nodules, abscesses, and the formation of tunnels (sinus tracts), most commonly found in the armpits, groin, and under the breasts. This condition arises from the occlusion and rupture of hair follicles, leading to deep inflammation and subsequent scarring. Because HS is a progressive disease that ranges widely in severity, its management requires a comprehensive and often multidisciplinary approach. The specific team of healthcare providers involved depends on the stage of the disease and the complexity of the patient’s symptoms.
The Primary Care Gateway
The journey for many individuals with HS begins with a Primary Care Provider (PCP), such as a family physician or internist. PCPs are often the first to encounter the painful lumps and abscesses of early HS, which can be mistaken for common boils or simple infections. Their initial role is to establish a suspicion of HS, differentiate it from other conditions, and begin an assessment.
This early evaluation often involves using the Hurley Staging system to categorize disease severity, which guides the urgency of a referral. For instance, a patient with a few isolated nodules without scarring (Hurley Stage I) may receive initial treatment before seeing a specialist. The PCP may prescribe short courses of oral antibiotics or recommend topical antiseptics to manage immediate symptoms. This ensures the patient is directed promptly to specialized care for definitive diagnosis and long-term management.
Dermatologists The Cornerstone of HS Management
Dermatologists are the medical specialists responsible for confirming the diagnosis of HS and leading the long-term treatment strategy. They possess the expertise to accurately classify the disease according to the Hurley stages, which dictates the therapeutic plan. This classification ranges from Stage I to Stage III (diffuse involvement with multiple interconnected sinus tracts and extensive scarring).
For milder cases, dermatologists manage symptoms using topical treatments, such as 1% clindamycin solution. They frequently employ intralesional injections of corticosteroids, like triamcinolone acetonide, directly into inflamed nodules to reduce localized swelling and pain. More widespread disease often requires systemic therapy, typically involving prolonged courses of oral antibiotics, such as doxycycline or a combination of clindamycin and rifampicin, administered for their anti-inflammatory effects.
In women, hormonal modulators like oral contraceptives or spironolactone may be prescribed to stabilize flares correlating with menstrual cycles. Dermatologists also manage wound care and provide education on lifestyle adjustments, such as smoking cessation and weight management. Their oversight ensures a coordinated medical response that adapts as the patient’s condition changes.
Specialized Medical and Systemic Care
For patients with moderate to severe HS (Hurley Stage II or III), treatment often requires specialized systemic therapies that modulate the body’s inflammatory response. Biologic medications, which target specific proteins involved in inflammation, are used for these complex cases. Examples include tumor necrosis factor-alpha (TNF-α) inhibitors (e.g., adalimumab) or interleukin (IL) inhibitors (e.g., secukinumab or bimekizumab), administered to suppress the underlying systemic inflammation driving the disease.
These systemic treatments require close monitoring and are managed in collaboration with specialists experienced in immunosuppressive agents, such as rheumatologists. HS is recognized as a systemic inflammatory disorder, often connected to conditions like inflammatory arthritis and Crohn’s disease. Pain management specialists are consulted to address chronic pain associated with lesions and scarring. Mental health professionals also play a supportive role, helping patients cope with the psychological burden of a chronic, visible skin condition.
Surgical Intervention Specialists
Surgery is an important component of the treatment plan for HS, particularly when chronic lesions and extensive scarring do not respond to medical therapy. The type of surgeon involved depends on the procedure’s complexity and the extent of the disease. Dermatologic surgeons commonly perform minimally invasive procedures, such as deroofing, where the skin over a sinus tract is removed to allow the open tunnel to heal.
For advanced or recurrent disease, General Surgeons or Plastic Surgeons are often required to perform wide local excisions. This involves removing the entire affected area, including deep tunnels and scarred tissue, to achieve sustained relief and reduce recurrence. Plastic surgeons may also be involved in complex cases requiring reconstructive techniques, such as skin grafts or flaps, to close the large wounds created by extensive excisions.