**9. Treatment**

HS is a complex and difficult-to-treat disease, with success rates depending on the stage of the disease. To efficiently control it, a multidisciplinary treatment should be offered with an early approach, involving clinical and preventive measures, psychological support, and surgery [21, 28].

Behaviors to mitigate the disease development are smoking cessation, weight management, avoiding mechanical friction, chemical and physical irritants such as shaving, and the use of deodorants [17, 21].

Drug therapy ranges from topical and systemic antibiotics, anti-inflammatory agents, retinoids, antiandrogens, fumarates, and biguanides to immunosuppressive therapy. Local therapies, such as laser, phototherapy, hyperbaric, surgical resections, and skin grafts, can be useful [28, 29].

Topical antibiotics such as clindamycin were found to reduce nodules, pustules, and abscesses and should be used in mild-to-moderate disease with limited extent [21, 28]. On the other hand, systemic antibiotics are necessary in advanced disease commonly used for a long period (10–12 weeks). There is evidence supporting that the prescription of rifampicin and clindamycin soften the pain and lessen lesions count and suppuration [28]. In a randomized controlled trial, the combination of oral antibiotics (rifampicin and clindamycin) and 20 sessions of hyperbaric oxygen therapy was significantly superior to antibiotics alone in improving HS symptoms [29, 30].

Intralesional injections of glucocorticoids also play a role in the treatment of mild HS with few nodules and have shown to be effective and alleviate pain rapidly [21, 31].

Immunosuppressive drugs, such as tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1), and interleukin-12/23 (IL-12/IL-23) inhibitors, are an option of
