Continuing medical education
Hidradenitis suppurativa: Current and emerging treatments

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The treatment of hidradenitis suppurativa (HS) has remained challenging because of the many knowledge gaps regarding etiology. However, recent studies into the pathogenesis of HS have enabled the investigation of newer therapies. The second article in this continuing medical education series reviews the evidence for established therapies for HS, including anti-inflammatories, antibiotics, and surgery. New and emerging therapies that specifically target cytokines involved in HS pathogenesis will be covered. The potential therapeutic roles of anticytokine therapies, including both the expanded application of existing molecules as well as the specific development of novel therapies for HS are discussed. With increased attention on HS and with numerous clinical trials currently underway, we hope that the variety of treatment options for HS will be expanded.

Section snippets

Established therapies

Key points

  1. Antibiotics are used to decrease inflammation and to treat secondary infection

  2. Systemic tetracyclines, alone or in combination with other agents, are frequently used as first-line treatments

  3. Prednisone does not have much benefit alone, but may increase the response to adalimumab

  4. Surgery remains an important treatment for HS; wide excision is the only known curative procedure

  5. Weight loss and smoking cessation counseling should be recommended for patients with HS

Biologic therapies

Key points

  1. Advances in the understanding of HS pathogenesis has guided studies to investigate the therapeutic role of biologics for this disease

  2. Tumor necrosis factor–α inhibitors are effective and safe for the treatment of HS; adalimumab is the only therapy for HS approved by the US Food and Drug Administration

  3. There are several ongoing clinical trials for newer biologic therapies targeting multiple cytokines

  4. It is likely that multiple immunologic pathways are implicated in HS progression, so complete

Other therapies

Key points

  1. Ethinyloestradiol, noregestrol, and cyproterone acetate have not been effective for HS treatment, but finasteride might decrease symptoms

  2. Systemic retinoids might decrease symptoms in younger patients with HS with acne and lower body weight

  3. For mild HS, a combination of antibacterial soap, warm compresses, and sodium dusidate 2% ointment may decrease lesion size and symptoms

References (110)

  • T. Kanni et al.

    MABp1 targeting IL-1α for moderate to severe hidradenitis suppurativa not eligible for adalimumab: a randomized study

    J Invest Dermatol

    (2018)
  • O. Babalola et al.

    Combined biologic therapy for the treatment of psoriasis and psoriatic arthritis: a case report

    JAAD Case Rep

    (2015)
  • K.M. Torre et al.

    Combination biologic therapy for the treatment of severe palmoplantar pustulosis

    JAAD Case Rep

    (2017)
  • A. Alikhan et al.

    North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management

    J Am Acad Dermatol

    (2019)
  • S. Hessam et al.

    Combination of oral zinc gluconate and topical triclosan: an anti-inflammatory treatment modality for initial hidradenitis suppurativa

    J Dermatol Sci

    (2016)
  • N.M. Golbari et al.

    Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

    J Am Acad Dermatol

    (2019)
  • I. Janse et al.

    Surgical procedures in hidradenitis suppurativa

    Dermatol Clin

    (2016)
  • A. Mehdizadeh et al.

    Recurrence of hidradenitis suppurativa after surgical management: a systematic review and meta-analysis

    J Am Acad Dermatol

    (2015)
  • H. John et al.

    A systematic review of the use of lasers for the treatment of hidradenitis suppurativa

    J Plast Reconstr Aesthet Surg

    (2016)
  • B.H. Mahmoud et al.

    Prospective controlled clinical and histopathologic study of hidradenitis suppurativa treated with the long-pulsed neodymium:yttrium-aluminium-garnet laser

    J Am Acad Dermatol

    (2010)
  • J.R. Ingram et al.

    Interventions for hidradenitis suppurativa

    Cochrane Database Syst Rev

    (2015)
  • J.R. Ingram et al.

    Management of hidradenitis suppurativa: a U.K. survey of current practice

    Br J Dermatol

    (2015)
  • S. Pradhan et al.

    Anti-inflammatory and immunomodulatory effects of antibiotics and their use in dermatology

    Indian J Dermatol

    (2016)
  • H.H. van der Zee et al.

    The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa

    Dermatology

    (2009)
  • L.A. Orenstein et al.

    Medical management of hidradenitis suppurativa

    Semin Cutan Med Surg

    (2017)
  • N. Scheinfeld

    Why rifampin (rifampicin) is a key component in the antibiotic treatment of hidradenitis suppurativa: a review of rifampin's effects on bacteria, bacterial biofilms, and the human immune system

    Dermatol Online J

    (2016)
  • T.L. Braunberger et al.

    Ertapenem - a potent treatment for clinical and quality of life improvement in patients with hidradenitis suppurativa

    Int J Dermatol

    (2018)
  • van Straalen KR, Schneider-Burrus S, Prens EP. Current and future treatment of hidradenitis suppurativa [E-pub ahead of...
  • V.K. Shanmugam et al.

    Review of current immunologic therapies for hidradenitis suppurativa

    Int J Rheumatol

    (2017)
  • P. Theut Riis et al.

    Investigational drugs in clinical trials for hidradenitis suppurativa

    Expert Opin Investig Drugs

    (2018)
  • A randomized controlled trial evaluating the efficacy of intralesional triamcinolone in hidradenitis suppurativa

  • N. Scuderi et al.

    Medical and surgical treatment of hidradenitis suppurativa: a review

    Skin Appendage Disord

    (2017)
  • C.B. Kromann et al.

    The influence of body weight on the prevalence and severity of hidradenitis suppurativa

    Acta Derm Venereol

    (2014)
  • L. Jennings et al.

    The treatment of hidradenitis suppurativa with the glucagon-like peptide-1 agonist liraglutide

    Br J Dermatol

    (2017)
  • A. Garg et al.

    Incidence of hidradenitis suppurativa among tobacco smokers: a population-based retrospective analysis in the U.S.A

    Br J Dermatol

    (2018)
  • A. Garg et al.

    Factors associated with point-of-care treatment decisions for hidradenitis suppurativa

    JAMA Dermatol

    (2016)
  • R. Micheletti

    Tobacco smoking and hidradenitis suppurativa: associated disease and an important modifiable risk factor

    Br J Dermatol

    (2018)
  • M. Maarouf et al.

    Targeted treatments for hidradenitis suppurativa: a review of the current literature and ongoing clinical trials

    J Dermatolog Treat

    (2018)
  • A. Balato et al.

    Anti-TNFα therapy modulates mTORC1 signalling in hidradenitis suppurativa

    J Eur Acad Dermatol Venereol

    (2019)
  • A.B. Kimball et al.

    Adalimumab for the treatment of moderate to severe hidradenitis suppurativa: a parallel randomized trial

    Ann Intern Med

    (2012)
  • A.B. Kimball et al.

    Two phase 3 trials of adalimumab for hidradenitis suppurativa

    N Engl J Med

    (2016)
  • Humira [package insert]. North Chicago, IL: AbbVie...
  • V. De Vita et al.

    The magnitude of mTORC1 signalling may predict the response to isotretinoin treatment in patients with hidradenitis suppurativa

    Dermatology

    (2017)
  • H.H. van der Zee et al.

    Failure of anti-interleukin-1 therapy in severe hidradenitis suppurativa: a case report

    Dermatology

    (2013)
  • L. Thorlacius et al.

    Severe hidradenitis suppurativa responding to treatment with secukinumab: a case report

    Br J Dermatol

    (2018)
  • A. Schuch et al.

    Successful treatment of severe recalcitrant hidradenitis suppurativa with the interleukin-17A antibody secukinumab

    Acta Derm Venereol

    (2018)
  • Exploratory trial evaluating cosentyx (secukinumab) for patients with moderate-to-severe hidradenitis suppurativa

  • Study of efficacy and safety of two secukinumab dose regimens in subjects with moderate to severe hidradenitis suppurativa (HS) (SUNRISE)

  • Odorici G, Pellacani G, Conti A. Ixekizumab in hidradenitis suppurativa: a case report in a psoriatic patient [E-pub...
  • J.L. Blok et al.

    Ustekinumab in hidradenitis suppurativa: clinical results and a search for potential biomarkers in serum

    Br J Dermatol

    (2016)
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    Funding sources: None.

    Date of release: May 2020

    Expiration date: May 2023

    Dr Strober serves as a consultant for AbbVie, Almirall, Amgen, Arena, Aristea, Boehringer Ingelheim, Bristol-Myers-Squibb, Celgene, Dermavant, Dermira, Janssen, Leo, Eli Lilly, Kyowa Hakko Kirin, Meiji Seika Pharma, Novartis, Pfizer, GlaxoSmithKline, UCB Pharma, Sun Pharma, Ortho Dermatologics, Regeneron, Sanofi-Genzyme. Dr Strober is also a speaker for AbbVie, Lilly, Janssen, Ortho Dermatologics. Dr Strober is also a scientific director for Corrona Psoriasis Registry. Dr Strober is also an investigator for Dermavant, AbbVie, Corrona Psoriasis Registry, Dermira. Dr Payette is a consultant for Abbvie Inc, Novartis, and Janssen Global Services.

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