title: Effective modified conservative tissue preserving protocol to treat stage I axillary hidradenitis suppurativa: a prospective cohort study of 627 patients with five years follow-up.
abstract: BACKGROUND
  Hidradenitis suppurativa is a chronic inflammatory cutaneous disorder that involves the infundibular terminal follicles in areas rich in apocrine glands and associated with the formation of abscesses and fistulating sinus. The clinical course is variable, and definitive evidence-based guidelines for the management are not well-established. Conservative treatment is controversial, and surgical excision is the recommended method. Herein, we aim to analyze the results of a modified conservative tissue preserving management protocol for stage I axillary hidradenitis suppurativa.
  
  
  METHODS
  A prospective cohort study of the results of 627 patients who were diagnosed and treated for stage I axillary hidradenitis suppurativa between January 2001 and December 2010 was done. Three hundred and forty nine (55.7%) were females, and 278 (44.3%) were males. The modified conservative treatment protocol consisted of three times per day washing the affected area with antibacterial soap, application of warm compresses for 10 min, followed by application of topical sodium fusidate 2% ointment (fusidic acid), with abstinence of armpits shaving during the treatment period.
  
  
  RESULTS
  Four hundred and sixty one (73.5%) patients had complete healing within two weeks, 127 (20.3%) within three weeks, 39 (6.2%) within four weeks. The recurrence rate was 5.9% (37 patients) in which all patients were retreated conservatively and had complete healing, none required surgical intervention.
  
  
  CONCLUSIONS
  We conclude that hidradenitis suppurativa continues to be a challenging disease for patients and physicians. Tissue preserving conservative method using the fusidic acid ointment for treating stage I axillary hidradenitis suppurativa showed a promising result. Further research should be conducted on the optimal treatment regimen.
authors.affiliation: a King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences , Jeddah , Saudi Arabia.
authors.forename: Bader Hamza
authors.identifier: http://orcid.org/0000-0001-6493-2155
authors.initials: BH
authors.lastname: Shirah
authors.affiliation: b Department of General Surgery , Al Ansar General Hospital , Medina , Saudi Arabia.
authors.forename: Hamza Asaad
authors.identifier: http://orcid.org/0000-0002-1983-8167
authors.initials: HA
authors.lastname: Shirah
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001365:Axilla; D005260:Female; D005500:Follow-Up Studies; D005672:Fusidic Acid / Q000627:therapeutic use; D017497:Hidradenitis Suppurativa / Q000188:drug therapy / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D014945:Wound Healing; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005672:Fusidic Acid
keywords: Hidradenitis suppurativa; conservative treatment; sodium fusidate 2% ointment (fusidic acid); surgical excision