Anti-Inflammatory Medications
These medications can be inject directly to the lesions or taken orally. Additionally, oral medications that contains corticosteroids can be used. However, due to their extensive side effects, long-term use of these drugs is not generally preferred.
Antibiotics
Antibiotics can be used for infected lesions with an abscess-like appearance in this disease. Studies have shown that cultures taken from abscess discharge contain bacteria from the normal skin flora. In some cases, gram-negative bacteria have also been detected. The protective layer called a biofilm, which is produced by these bacteria, has been more commonly identified in HS lesions compared to normal human flora bacteria. Therefore, this factor should not be overlooked when starting antibiotics for treatment.
Immunosuppressive Drugs
These drugs are the ones that suppress the immune system. They can effectively suppress TNF (Tumor Necrosis Factor), which plays a significant role in our immune system. However, due to their extensive side effects, long-term usage of these drugs is unfortunately not recommended. Additionally, there is a risk of reaccurrence due to the persistence of affected tissues after these treatments.
Painkillers
The severity of pain can vary depending on the location of the lesions, ranging from starting with a simple nonsteroidal anti-inflammatory drug to using morphine and its derivatives to alleviate pain. Care should be taken to be aware of the addictive effects of frequent morphine use. Tramadol, a morphine derivative, is used as an alternative to morphines due to cardiovascular complications. Anticonvulsants like pregabalin and gabapentin can improve neuropathic pain but should be used carefully.
Surgical Treatments
Among surgical treatments, removal of formed fistulas, surgical drainage of established abscesses, excision of small nodules, as well as extensive skin excisions in cases with larger lesions, can be successfully performed. In patients with extensive lesions, after the removal of the affected skin, skin grafts can be applied to these areas, or skin tissues called “flaps” from surrounding tissues can be shifted to the excised area and sutured. In addition, after the removal of extensive lesions, applications known as absorbent dressings, such as serial VAC (Vacuum-Assisted Closure) treatments, and subsequent graft or patch applications, play a crucial role in terms of the vitality of the wound. This absorbent VAC dressing helps reduce the bacterial load in the remaining tissue, resulting in a cleaner and more vibrant wound surface, which is an important contribution to the viability of potential grafts.
