Make accurate diagnosis – inflamed nodules, open comedones, sinus tracts, bridging scars. In flexures. May be family history. Usually 2 lesions in 6/12 or 5+ in lifetime. If severe disease, immediately refer to secondary care.
Baseline assessment = screen for impact of disease (e.g. DLQI), depression/anxiety, pain. Severity of disease (Hurley stage – https://dermnetnz.org/topics/hidradenitis-suppurativa-severity-assessment)
Give PIL (BAD leaflet - https://www.bad.org.uk/shared/get-file.ashx?id=88&itemtype=document)
Dressings if needed – adequate amounts (e.g. Hidrawear)
Address smoking and weight if needed
Screen for cardiovascular risk – BP, lipids, HBA1c
**Clindamycin important info - Stop if diarrhoea develops – predisposes to C. diff. infection, contraindicated in pregnancy.
*Rifampicin important info - Can colour urine/contact lenses, additional contraceptive measures required, see BNF chapter, ‘Contraceptives, interactions’ for guidance, requires monitoring: Before commencing treatment the BNF advises checking U&E and LFT, if these are normal then further checks are usually unnecessary as liver damage is rare, and if it does occur it is usually within the first six weeks of treatment. Patients should be advised to stop treatment and seek urgent medical attention should they develop signs of hepatotoxicity (fever, malaise, vomiting, jaundice)
OTHER USEFUL LINKS:
1. Ingram J, Collier F, Brown D et al. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018. Br J Dermatol 2018; 180 (5): 1009–1017.