HS is a chronic, debilitating inflammatory dermatosis that is often refractory to treatment. Many medical therapies have been tried and some show efficacy. The introduction of new immunosuppressive medications has revolutionized the treatment of psoriasis in dermatology. These therapies have the potential to powerfully abort the molecular signals driving inflammation in HS and perhaps even induce a remission. This may offer patients an alternative to radical excisional surgery. However, more studies are needed to evaluate the long-term effects of these medications, particularly in light of their association with an increased risk of malignancy and infection. Evaluation of treatment efficacy has been hindered by a lack of uniform standards to track treatment response. The classic clinical classification system has limitations but is a useful scheme to guide selection of treatments. Further laboratory studies may be warranted, depending on the clinical presentation (Box 3). While there are many approaches to treating HS, the authors offer an algorithm based on disease severity (Fig. 9). It is important to address many patient-oriented concerns, such as the pain, dampness, and smell associated with draining sinuses. Communication with the patient about expectations is important to direct treatment. Often a multidisciplinary approach involving dermatology, plastic surgery, gynecology, and urology may be necessary to diagnose and treat the disease. Both medical and surgical options should be explored before embarking on therapy.
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