Medical treatment
- Oral isotretinoin: 0.5–1 mg/kg/day for 4–6 months ( treatment of choice).
- Isotretinoin and systemic steroids ( prednisolone 1 mg/kg/day for 2–4 weeks ).
- Combination of isotretinoin and oral antibiotics ( erythromycin 1 g daily or trimethoprim 200–300 mg b.d ).
- Dapsone : 50-150 mg/d for resistant cases.
- Tetracycline
Tetracyclines should not be combined with oral isotretinoin because it may induce pseudotumor cerebri.
- Etanercept : 25 mg twice a week Plus isotretinoin 20 mg weekly for 3 months. Etanercept then tapered to once a week for 1 month then alternate weeks for 2 months and isotretinoin reduced to 10 mg daily.1
- Infliximab: 3 mg/kg. Week 0, 2 and 6. Alternate months thereafter.2
- Adalimumab: 80 mg loading dose followed by 40 mg twice monthly.3
Physical treatment
- Surgery may be required to lay open abscesses and sinus tracts
- Resultant scarring may be improved with the fractional laser postsurgical intervention
- Large nodules may be aspirated and injection with intralesional triamcinolone or cryotherapy may be benefcial
- Fluorescent light energy
- Modern beam radiation