The nodules of hidradenitis suppurativa should be drained in the ED if they are very large, fluctuant, and painful. Antibiotics are indicated if cellulitis or fever is present, and admission should be considered if the patient appears toxic. Surgical consultation may be obtained for removal of sinus tracts, curettage, and exteriorization of the gland. Excision and skin grafting may be helpful for severe intractable cases. The CO 2 laser has been used to strip away glandular tissue.
Healing is by secondary intention.
Topical products, such as benzoyl peroxide, may be helpful. Retin-A has been found to be helpful in some patients. Accutane can reduce the severity of attacks in some patients but is not a reliable cure for hidradenitis suppurativa. Antibiotics - Therapy must cover all likely pathogens in the context of the clinical setting. In recurrent disease, antibiotics may be administered for 2 or more months.