Adjunct treatments for hidradenitis suppurativa

While waiting for dermatologist assessment, adjunct treatments for hidradenitis suppurativa can be considered instead of or in addition to oral antibiotic therapy . Adjunct treatments may include the combined oral contraceptive pill, spironolactone and metformin.

Spironolactone is contraindicated in pregnancy because of the risk of defective virilisation of the male fetus. Exclude pregnancy before starting treatment and ensure use of effective contraception during therapy. Stop spironolactone when planning pregnancy, or when pregnancy is suspected or confirmed.

Adverse effects of spironolactone include irregular menstrual bleeding (the combined oral contraceptive pill can reduce this risk and provides reliable contraception, if this is being used by the patient concurrently), postmenstrual spotting, and breast tenderness or lumpiness.

For interim treatment of hidradenitis suppurativa in females (while waiting for dermatologist review), consider:

In all females, measure blood pressure, and kidney and liver function before starting spironolactone, then every 6 months. Older females may need more frequent monitoring if clinically indicated.

Metformin can be considered in both females and males for hidradenitis suppurativa, particularly if there are other indications for its use (eg polycystic ovary syndrome, diabetes)Ingram, 2019Jennings, 2020. For interim treatment of hidradenitis suppurativa (while waiting for dermatologist review), consider:

Metformin doses are usually titrated according to patient response and tolerance.