What is the preferred treatment for hidradenitis suppurativa in an adolescent?

1.

Martin, Kari L. (2025). In Nelson Textbook of Pediatrics (pp. 4134). DOI: 10.1016/B978-0-323-88305-4.00702-1

Conservative management includes cessation of smoking, weight loss, and avoidance of irritation of the affected area. Warm compresses and topical antiseptic or antibacterial soaps may also be helpful. For mild, early disease, topical clindamycin 1% may be helpful. For more severe disease, therapy may be initiated with doxycycline (100 mg bid) or minocycline (100 mg bid) in adolescents and young adults. Some patients require intermittent or long-term antibiotic treatment. Combination therapy with clindamycin and rifampin is helpful in some patients. Oral retinoids for 5-6 months may also be effective, although disease may recur. Oral contraceptive agents, which contain a high estrogen:progesterone ratio and low androgenicity of the progesterone, are another alternative along with spironolactone. Laser hair ablation has proven helpful in some studies as well. Systemic immunosuppressants (infliximab, adalimumab, cyclosporine, anakinra) and medications targeted at glucose metabolism and metabolic syndrome (metformin) have been helpful in patients resistant to more traditional measures. Adalimumab, a tumor necrosis factor-alpha (TNF-α) inhibitor, is the only FDA-approved medication for the treatment of moderate-to-severe HS. Surgical measures, including deroofing procedures and full excision, may be a helpful adjuvant to medical therapy, especially in recalcitrant cases.

2.

Elsevier ClinicalKey Derived Clinical Overview

• Adjuvant therapy, which includes pain management, treatment of established superinfections, weight loss, and tobacco cessation. Treatment of superinfections is directed by bacterial culture sensitivities. Appropriate bandaging of suppurating lesions and patient support groups are helpful. • Medical therapy, which may be topical in mild cases. Topical clindamycin has been shown to have an effect on early lesions. Resorcinol 15% BD can also be used as first-line treatment. Systemic tetracycline (500 mg BD) or doxycycline (100 mg BD) may be used as an alternative for severe/refractory disease. Cohort studies support coadministering oral clindamycin 300 mg BD and rifampicin 300 mg BD for limited HS. Smaller studies indicate that long-term intensive antibiotic treatment, e.g., the oral combination of rifampin (10 mg/kg once daily), moxifloxacin (400 mg once daily), and metronidazole (250–500 mg TD) (RMoM) for 6 wk, followed by 4 wk of RMo alone; cotrimoxazole after remission may provide long-term disease control in mild cases. Antibiotic resistance is frequent in the microbiota of HS patients and calls for more stringent antibiotic stewardship. For localized flares, intralesional corticosteroids (3–5 mg single dose) may provide significant pain relief within 24 hr. Adalimumab has been shown to be effective in moderate-to-severe HS when administered weekly (week 0: 160 mg; week 2: 80 mg; and from week 4: 40 mg weekly). Onset of effect has been shown to be at week 2 of treatment. A post hoc analysis of a smaller trial indicated that infliximab 5 mg/kg may also be effective. Anakinra (100 mg daily) and apremilast (30 mg BD) may also be effective. An open-label study of ustekinumab (45 mg or 90 mg based on patient weight) also indicated utility.

An open-label study of ustekinumab (45 mg or 90 mg based on patient weight) also indicated utility. • Surgery, from local to extensive, can be helpful. Milder cases can benefit from localized excisions or deroofing (exteriorization) of single tunnels. Only fluctuant soft abscesses should undergo lancing. Lancing of inflamed nodules is painful to the patient, is ineffective, and causes additional scarring. Nonfluctuant symptomatic lesions are better treated using intralesional corticosteroids. A CO2laser can be used to evaporate lesions. More advanced cases require major surgery, which should involve excision of the affected tissue or careful deroofing of all tunnels. The recurrence rate is inversely proportional to the extent of surgery, and wide excisions generally offer a better chance of remission. Similarly, it is suggested that secondary intention healing is superior to primary closure of postexcisional wounds. Secondary healing requires longer periods of wound management but generally does not preclude resumption of work 3 to 4 wk after treatment.

3.

Elsevier ClinicalKey Drug Monograph

Content last updated: April 3, 2024.

Indications And Dosage Subcutaneous dosage (Humira) Adults: 160 mg subcutaneously (given in 1 day or split over 2 consecutive days) followed by 80 mg subcutaneously on Day 15. Begin maintenance treatment of 40 mg subcutaneously once weekly or 80 mg subcutaneously every other week on Day 29. In 2 placebo-controlled trials evaluating patients with Hurley Stage II or III disease and with at least 3 abscesses or inflammatory nodules treated with 12 weeks of amjevita, more patients in the amjevita group (42% to 59%) achieved Hidradenitis Suppurativa Clinical Response (HiSCR), defined as at least a 50% reduction in total abscess and inflammatory nodule count with no increase in abscess count and no increase in draining fistula relative to baseline vs. 26% to 28% with placebo. Children and Adolescents 12 to 17 years weighing 60 kg or more: 160 mg subcutaneously (given in 1 day or split over 2 consecutive days) followed by 80 mg subcutaneously on Day 15. Begin maintenance treatment of 40 mg subcutaneously once weekly or 80 mg subcutaneously every other week on Day 29. Children and Adolescents 12 to 17 years weighing 30 to 59 kg: 80 mg subcutaneously on Day 1. Begin maintenance treatment of 40 mg subcutaneously once every other week on Day 8. Subcutaneous dosage (Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Simlandi, Yuflyma, and Yusimry) Adults: 160 mg subcutaneously (given in 1 day or split over 2 consecutive days), followed by 80 mg subcutaneously on Day 15. Begin maintenance treatment of 40 mg subcutaneously once weekly or 80 mg subcutaneously every other week on Day 29.

4.

Food and Drug Administration (DailyMed).

Publish date: May 4, 2024.

Dosage And Administration Begin 40 mg weekly or 80 mg every other week dosing two weeks later (Day 29). Adolescents The recommended subcutaneous dosage of HUMIRA (adalimumab) for adolescent patients 12 years of age and older weighing at least 30 kg with hidradenitis suppurativa (HS) is based on body weight as shown below [see Use in Specific Populations ( 8.4 ) and Clinical Pharmacology ( 12.3 ) ] : Body Weight of Adolescent Patients (12 years of age and older) Recommended Dosage 30 kg (66 lbs) to less than 60 kg (132 lbs) Day 1: 80 mg Day 8 and subsequent doses: 40 mg every other week 60 kg (132 lbs) and greater Day 1: 160 mg (given in one day or split over two consecutive days); Day 15: 80 mg Day 29 and subsequent doses: 40 mg every week or 80 mg every other week 2.7 Monitoring to Assess Safety Prior to initiating HUMIRA (adalimumab) and periodically during therapy, evaluate patients for active tuberculosis and test for latent infection [see Warnings and Precautions ( 5.1 ) ]. 2.8 General Considerations for Administration HUMIRA (adalimumab) is intended for use under the guidance and supervision of a physician. A patient may self-inject HUMIRA (adalimumab) or a caregiver may inject HUMIRA (adalimumab) using either the HUMIRA (adalimumab) Pen or prefilled syringe if a physician determines that it is appropriate, and with medical follow-up, as necessary, after proper training in subcutaneous injection technique. HUMIRA (adalimumab) can be taken out of the refrigerator for 15 to 30 minutes before injecting to allow the liquid to come to room temperature. Do not remove the cap or cover while allowing it to reach room temperature. Carefully inspect the solution in the HUMIRA (adalimumab) Pen, prefilled syringe, or single-dose institutional use vial for particulate matter and discoloration prior to subcutaneous administration. If particulates and discolorations are noted, do not use the product.

Dosage And Administration Discontinue in patients without evidence of clinical remission by eight weeks (Day 57). Pediatric Patients 5 Years of Age and Older : Pediatric Weight Recommended Dosage Days 1 through 15 Starting on Day 29* 20 kg (44 lbs) to less than 40 kg (88 lbs) Day 1: 80 mg Day 8: 40 mg Day 15: 40 mg 40 mg every other week or 20 mg every week 40 kg (88 lbs) and greater Day 1: 160 mg (single dose or split over two consecutive days) Day 8: 80 mg Day 15: 80 mg 80 mg every other week or 40 mg every week * Continue the recommended pediatric dosage in patients who turn 18 years of age and who are well-controlled on their HUMIRA (adalimumab) regimen. Plaque Psoriasis or Adult Uveitis ( 2.5 ) : Adults : 80 mg initial dose, followed by 40 mg every other week starting one week after initial dose. Hidradenitis Suppurativa ( 2.6 ) : Adults: ○ Day 1: 160 mg (given in one day or split over two consecutive days) ○ Day 15: 80 mg ○ Day 29 and subsequent doses: 40 mg every week or 80 mg every other week Adolescents 12 years of age and older: Adolescent Weight Recommended Dosage 30 kg (66 lbs) to less than 60 kg (132 lbs) Day 1: 80 mg Day 8 and subsequent doses: 40 mg every other week 60 kg (132 lbs) and greater Day 1: 160 mg (given in one day or split over two consecutive days) Day 15: 80 mg Day 29 and subsequent doses: 40 mg every week or 80 mg every other week 2.1 Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis The recommended subcutaneous dosage of HUMIRA (adalimumab) for adult patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis (AS) is 40 mg administered every other week.