The correct answer is C. Initiate weekly adalimumab therapy.

Note the patient’s diagnosis of hidradenitis suppurativa, which has progressed to later stages with the formation of tracts. Weekly adalimumab therapy has been shown to be effective in patients with hidradenitis suppurativa in multiple clinical trials.

Admission to the hospital for ertapenem may be needed in some patients, though this patient likely does not require hospital admission. Topical clindamycin may be considered, but this patient has progressive disease and should be initiated on biologic therapy. Weight loss can help with the condition, but because of disease progression, biologics are essential. Apremilast should be used cautiously in patients with a history of depression; moreover, it has shown mixed results with some studies showing success but others showing no significant changes in inflammatory markers.

References: Lim SYD, Oon HH. Systematic review of immunomodulatory therapies for hidradenitis suppurativa. Biologics. 2019;13:53-78. Published 2019 May 13. doi:10.2147/BTT.S199862