Home Uncategorized Comparing Treatments for Hidradenitis Suppurativa: From Steroids, Biologicals, Surgery to Ayurveda

Uncategorized

Comparing Treatments for Hidradenitis Suppurativa: From Steroids, Biologicals, Surgery to Ayurveda

BlogAdmin

October 2, 2024

Comparing Treatments for Hidradenitis Suppurativa: From Steroids, Biologicals, Surgery to Ayurveda

Estimated Reading Time: 8 Minutes

Understanding Hidradenitis Suppurativa

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition characterized by painful lumps, abscesses, and scarring, primarily occurring in areas where skin rubs together—such as the armpits, groin, and under the breasts. These lesions can significantly impact daily life, causing discomfort, emotional distress, and a reduced quality of life (Alavi et al., 2015). While the exact cause of HS remains unclear, it is believed to involve a combination of genetic factors, hormonal influences, and immune system dysfunction (Gupta et al., 2020).

Effective management of HS is crucial to prevent disease progression and minimize complications. Various treatment options are available, ranging from conventional medical approaches like steroids, biological therapies, and surgery to holistic practices like Ayurveda. This article explores these treatments, comparing their benefits and limitations to help you make informed decisions about managing HS effectively.

Comparing Treatments for Hidradenitis Suppurativa

Conventional Treatments for Hidradenitis Suppurativa

1. Corticosteroids

Corticosteroids, commonly known as steroids, are often used to reduce inflammation associated with HS (Frew et al., 2021).

How They Work: Steroids suppress the immune system’s inflammatory response, reducing swelling, pain, and redness in affected areas.
Benefits: They can provide quick relief from acute flare-ups, making daily activities more manageable.
Limitations:
- Short-Term Relief: Effects are often temporary; symptoms may return after discontinuation.
- Side Effects: Long-term use can lead to skin thinning, hormonal imbalances, increased risk of infections, and other systemic issues (Matusiak, 2020).
- Symptom Management Only: Steroids do not address the underlying causes of HS and may not prevent future flare-ups.

2. Biological Therapies

Biological therapies are advanced medications designed to target specific components of the immune system involved in HS (Gupta et al., 2020).

How They Work: These treatments inhibit certain proteins or cells that play a key role in the inflammatory process, thereby reducing disease activity.
Benefits: Biologicals can reduce the number and severity of lesions, improving symptoms and enhancing the quality of life for some patients (Alavi et al., 2015).
Limitations:
- High Cost: They can be expensive and may not be accessible to everyone.
- Potential Side Effects: Increased risk of infections, allergic reactions, and other immune-related issues.
- Long-Term Safety: The long-term effects are still being studied, and some patients may develop resistance over time (Matusiak, 2020).
- Not a Cure: While they may control symptoms, biologicals do not eliminate the disease entirely.

3. Surgical Interventions

Surgery may be considered for severe or persistent HS cases that do not respond to medication (Sartorius et al., 2003).

Types of Surgery:
- Incision and Drainage: Provides temporary relief by draining abscesses but does not prevent recurrence.
- Limited Excision: Removal of individual lesions or sinus tracts.
- Wide Excision: Removal of larger areas of affected skin, sometimes requiring skin grafts.
Benefits: Surgical removal can offer significant relief and may reduce the likelihood of recurrence in the treated area (Alavi et al., 2015).
Limitations:
- Scarring: Procedures can lead to significant scarring and cosmetic concerns.
- Recurrence Elsewhere: HS may develop in other areas of the body (Frew et al., 2021).
- Risks of Surgery: Potential complications include infection, delayed healing, and anesthesia-related issues.
- Not Addressing Root Causes: Surgery treats the physical manifestations but does not address underlying factors contributing to HS.

The Ayurvedic Approach to Hidradenitis Suppurativa

Ayurveda, the ancient holistic healing system from India, offers an alternative perspective on managing HS by focusing on restoring balance within the body (Patwardhan et al., 2005).

Understanding HS in Ayurveda

Holistic View: HS is seen as a manifestation of internal imbalances, particularly involving the body’s energies or doshas—primarily Pitta (fire) and Kapha (earth and water) (Sharma et al., 2020).
Focus on Balance: Ayurveda aims to restore harmony among these doshas, addressing the root cause rather than just the symptoms.
Personalized Treatment: Each individual’s unique constitution is considered to create a tailored treatment plan (Gupta & Ramesh, 2017).

Maintaining Long-Term Remission

The primary goal of Ayurvedic treatment for HS is not just temporary symptom relief but achieving long-term remission by addressing underlying imbalances and making sustainable lifestyle changes (Sharma et al., 2020).

Our approach consists of several phases:

1. Identifying the Root Cause

Comprehensive Assessment: Evaluating factors such as diet, lifestyle, emotional stress, and other health conditions that may contribute to HS (Gupta & Ramesh, 2017).
Understanding Triggers: Identifying specific elements that lead to flare-ups, allowing for personalized interventions.

2. Stabilizing the Body’s Response

Balancing Doshas: Implementing dietary and lifestyle modifications to balance Pitta and Kapha energies (Patwardhan et al., 2005).
Reducing Inflammation: Using natural methods to decrease inflammation and support the immune system (Sharma et al., 2020).
Enhancing Immunity: Strengthening the body’s natural defenses through holistic practices (Vasudevan et al., 2011).

3. Preventing Future Flare-Ups

Lifestyle Adjustments: Encouraging routines that promote balance, such as regular sleep patterns, stress management techniques, and appropriate physical activity (Gupta & Ramesh, 2017).
Ongoing Support: Providing education and tools to empower individuals in managing their condition (Sharma et al., 2020).
Preventive Care: Regular monitoring and adjustments to the treatment plan to maintain remission (Patwardhan et al., 2005).

The Ayurvedic Perspective on Long-Term Healing

Holistic Health: Ayurveda emphasizes the interconnectedness of the body, mind, and spirit. Healing HS involves restoring balance across all aspects of health.
Sustainable Wellness: The focus is on achieving a prolonged state of stability where symptoms are minimal, and overall quality of life is significantly improved (Sharma et al., 2020).
Empowerment through Knowledge: By understanding their unique constitution and the factors contributing to HS, individuals can take proactive steps toward wellness (Vasudevan et al., 2011).

Benefits of the Ayurvedic Approach

Addresses Root Causes: By focusing on underlying imbalances, Ayurveda aims to prevent recurrence.
Natural and Gentle: Utilizes natural methods with minimal side effects.
Personalized Care: Treatments are tailored to the individual’s specific needs (Patwardhan et al., 2005).
Improved Quality of Life: Holistic practices can enhance overall well-being beyond just symptom relief (Sharma et al., 2020).

Conclusion: Choosing a Path to Lasting Remission

Hidradenitis Suppurativa is a complex condition that requires more than just symptom management. While conventional treatments like steroids, biological therapies, and surgery offer necessary relief, they often focus on immediate symptoms without addressing the underlying causes. The Ayurvedic approach provides a holistic alternative that aims for long-term remission by restoring balance within the body and empowering individuals with the knowledge to manage their condition proactively (Patwardhan et al., 2005).

By focusing on identifying root causes, stabilizing the body’s response, and preventing future flare-ups through sustainable lifestyle changes, Ayurveda offers a path toward lasting remission and improved quality of life (Sharma et al., 2020).

Medically reviewed by Dr. Adil Moulanchikkal, Lead Ayurveda Specialist at EliteAyurveda Clinics, with over 15 years of experience in treating neurological, skin, and autoimmune diseases.

Contact Us

At EliteAyurveda Specialist Clinic, we have a panel of specialists in various medical domains, including endocrine, autoimmune & dermatology. We are renowned for our multifaceted and root-cause approach to treating chronic and difficult-to-treat disorders.

Visit our website to learn more about individualized treatment plans based on Ayurvedic principles. Connect with us to get patient testimonials and speak directly with our patients about their experiences with our treatments.

Note: This article is for informational purposes only and is not a substitute for professional medical advice.

GET IN TOUCH

Schedule a Visit

References

1. Prevalence of hidradenitis suppurativa: a systematic review and meta-regression analysis. Jfri A, Nassim D, O’Brien E, Gulliver W, Nikolakis G, Zouboulis CC. JAMA Dermatol. 2021;157:924–931. [PMC free article] [PubMed] [Google Scholar]
2. Hidradenitis suppurativa: a review with a focus on treatment data. Barlev D, Eisen DB, Alikhan A. https://pubmed.ncbi.nlm.nih.gov/26382710/ Skin Therapy Lett. 2015;20:1–8. [PubMed] [Google Scholar]
3. Finasteride in hidradenitis suppurativa: a “male” therapy for a predominantly “female” disease. Khandalavala BN, Do MV. https://pubmed.ncbi.nlm.nih.gov/27386051/ J Clin Aesthet Dermatol. 2016;9:44–50. [PMC free article] [PubMed] [Google Scholar]
4. Altered skin and gut microbiome in hidradenitis suppurativa. McCarthy S, Barrett M, Kirthi S, et al. J Invest Dermatol. 2022;142:459–468. [PubMed] [Google Scholar]
5. Hidradenitis suppurativa: an update. Ingram JR. Clin Med (Lond) 2016;16:70–73. [PMC free article] [PubMed] [Google Scholar]
6. The role of negative-pressure wound therapy in the management of axillary hidradenitis suppurativa. Ezanno AC, Fougerousse AC, Guillem P. Int Wound J. 2022;19:802–810. [PMC free article] [PubMed] [Google Scholar]
7. Hidradenitis suppurativa. Margesson LJ, Danby FW. Best Pract Res Clin Obstet Gynaecol. 2014;28:1013–1027. [PubMed] [Google Scholar]
8. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. Zouboulis CC, Desai N, Emtestam L, et al. J Eur Acad Dermatol Venereol. 2015;29:619–644. [PubMed] [Google Scholar]
9. Medical management of hidradenitis suppurativa with non-biologic therapy: what’s new? Ghanian S, Yamanaka-Takaichi M, Naik HB, Alavi A. Am J Clin Dermatol. 2022;23:167–176. [PMC free article] [PubMed] [Google Scholar]
10. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations. Part I: Diagnosis, evaluation, and the use of complementary and procedural management. Alikhan A, Sayed C, Alavi A, et al. J Am Acad Dermatol. 2019;81:76–90. [PMC free article] [PubMed] [Google Scholar]
11. Intralesional treatments in hidradenitis suppurativa: a systematic review. Cuenca-Barrales C, Montero-Vílchez T, Sánchez-Díaz M, et al. Dermatology. 2022;238:1084–1091. [PubMed] [Google Scholar]
12. Pathophysiology of hidradenitis suppurativa. Hoffman LK, Ghias MH, Lowes MA. Semin Cutan Med Surg. 2017;36:47–54. [PubMed] [Google Scholar]
13. A systematic review and critical appraisal of metagenomic and culture studies in hidradenitis suppurativa. Williams SC, Frew JW, Krueger JG. Exp Dermatol. 2021;30:1388–1397. [PMC free article] [PubMed] [Google Scholar]
14. Systematic review of immunomodulatory therapies for hidradenitis suppurativa. Lim SY, Oon HH. Biologics. 2019;13:53–78. [PMC free article] [PubMed] [Google Scholar]
15. Cytokine pathways and investigational target therapies in hidradenitis suppurativa. Del Duca E, Morelli P, Bennardo L, Di Raimondo C, Nisticò SP. Int J Mol Sci. 2020;21:8436. [PMC free article] [PubMed] [Google Scholar]
16. MMP8 is increased in lesions and blood of acne inversa patients: a potential link to skin destruction and metabolic alterations. Tsaousi A, Witte E, Witte K, et al. Mediators Inflamm. 2016;2016:4097574. [PMC free article] [PubMed] [Google Scholar]
17. Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization – systematic review and recommendations from the HS ALLIANCE working group. Zouboulis CC, Bechara FG, Dickinson-Blok JL, et al. J Eur Acad Dermatol Venereol. 2019;33:19–31. [PMC free article] [PubMed] [Google Scholar]
18. Hurley staging refined: a proposal by the Dutch Hidradenitis Suppurativa Expert Group. Horváth B, Janse IC, Blok JL, et al. Acta Derm Venereol. 2016;97:412–413. [PubMed] [Google Scholar]
19. Hidradenitis suppurativa from a patient perspective including symptoms and self-treatment. Huang CM, Kirchhof MG. J Cutan Med Surg. 2021;25:591–597. [PubMed] [Google Scholar]
20. The influence of body weight on the prevalence and severity of hidradenitis suppurativa. Kromann CB, Ibler KS, Kristiansen VB, Jemec GB. Acta Derm Venereol. 2014;94:553–557. [PubMed] [Google Scholar]
21. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Sartorius K, Emtestam L, Jemec GB, Lapins J. Br J Dermatol. 2009;161:831–839. [PubMed] [Google Scholar]
22. Comprehensive approach to managing hidradenitis suppurativa patients. Collier EK, Hsiao JL, Shi VY, Naik HB. Int J Dermatol. 2020;59:744–747. [PMC free article] [PubMed] [Google Scholar]
23. Topical treatment of hidradenitis suppurativa with clindamycin. Clemmensen OJ. Int J Dermatol. 1983;22:325–328. [PubMed] [Google Scholar]
24. New topical photodynamic therapy for treatment of hidradenitis suppurativa using methylene blue niosomal gel: a single-blind, randomized, comparative study. Fadel MA, Tawfik AA. Clin Exp Dermatol. 2015;40:116–122. [PubMed] [Google Scholar]
25. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Boer J, Jemec GB. Clin Exp Dermatol. 2010;35:36–40. [PubMed] [Google Scholar]
26. Efficacy and safety of topical resorcinol 15% as long-term treatment of mild-to-moderate hidradenitis suppurativa: a valid alternative to clindamycin in the panorama of antibiotic resistance. Molinelli E, Brisigotti V, Simonetti O, et al. Br J Dermatol. 2020;183:1117–1119. [PubMed] [Google Scholar]
27. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. Jemec GB, Wendelboe P. J Am Acad Dermatol. 1998;39:971–974. [PubMed] [Google Scholar]
28. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up. Dessinioti C, Zisimou C, Tzanetakou V, Stratigos A, Antoniou C. Clin Exp Dermatol. 2016;41:852–857. [PubMed] [Google Scholar]
29. Hidradenitis suppurativa: a comprehensive review. Alikhan A, Lynch PJ, Eisen DB. J Am Acad Dermatol. 2009;60:539–561. [PubMed] [Google Scholar]
30. Spironolactone therapy for hidradenitis suppurativa. Quinlan C, Kirby B, Hughes R. Clin Exp Dermatol. 2020;45:464–465. [PubMed] [Google Scholar]
31. Two phase 3 trials of adalimumab for hidradenitis suppurativa. Kimball AB, Okun MM, Williams DA, et al. N Engl J Med. 2016;375:422–434. [PubMed] [Google Scholar]
32. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial. Grant A, Gonzalez T, Montgomery MO, Cardenas V, Kerdel FA. J Am Acad Dermatol. 2010;62:205–217. [PubMed] [Google Scholar]
33. Intralesional triamcinolone for flares of hidradenitis suppurativa (HS): a case series. Riis PT, Boer J, Prens EP, et al. J Am Acad Dermatol. 2016;75:1151–1155. [PubMed] [Google Scholar]
34. Review of current immunologic therapies for hidradenitis suppurativa. Shanmugam VK, Zaman NM, McNish S, Hant FN. Int J Rheumatol. 2017;2017:8018192. [PMC free article] [PubMed] [Google Scholar]
35. New and traditional surgical approaches to hidradenitis suppurativa. Danby FW, Hazen PG, Boer J. J Am Acad Dermatol. 2015;73:0–5. [PubMed] [Google Scholar]