For hidradenitis suppurativa, what is the initial step in management?

• A. Lifestyle modification
• B. Mild disease: topical clindamycin
• C. Moderate-severe disease: TNF inhibitors
• D. Surgical excision

Answer: (A)

Hidradenitis suppurativa is a chronic inflammatory skin condition where disease activity is strongly influenced by modifiable lifestyle factors. The first step in management focuses on changing those factors, especially smoking cessation and weight loss. Smoking amplifies inflammation and follicular occlusion, while obesity increases inflammatory mediators and mechanical stress in affected areas. By reducing these triggers, patients often experience fewer flares and a better response to any medical therapy added later. General skin care and avoiding friction in affected regions also help.

Once lifestyle changes are underway, treatment can progress to medications for mild disease (such as topical antibiotics) or systemic therapies for more active disease, with surgery reserved for chronic, resistant lesions.