A study on the management of hidradenitis suppurativa with retinoids and surgical excision

Abstract

Background:Hidradenitis suppurativa is a chronic skin condition involving the apocrine glandular zones. Affected patients may present with acute abscesses, but the condition often progresses to a chronic state with persistent pain, sepsis, sinus tract, fistula formation, purulent discharge, and dermal scarring. The treatment of patients with severe disease can be difficult and may require complex surgical intervention.Materials and Methods:For this study, we selected 30 patients from the outpatient department. The patients were divided into two groups of 15 patients each. In patients of group I, oral acitretin 0.5 mg/kg body weight was given alone. Oral acitretin was given for a period of 12 weeks, and follow-up of the patients was done every 4 weeks for a period of 6 months. In patients of group II, oral acitretin 0.5 mg/kg was given plus a wide surgical excision was done.Results and Discussion:In our study, the commonest site of involvement of hidradenitis suppurativa was axilla in 83.3% patients, perineum was involved in 13.3% patients, and periumbilical involvement was seen in 3.3% patients. The commonest clinical feature was nodules seen in 90% patients; pain was seen in 60% patients, dermal scarring in 73.3% patients, malodorous discharge in 33.3% patients, abscess in 30% patients, and fistulous tracts were seen in 20% patients. The recurrence rate was low (20%) in group II patients in whom oral acitretin was given plus surgical excision was done as compared with group I (40%) in whom oral acitretin was given alone.

Hidradenitis suppurativa/Acne inversa: an endocrine skin disorder?

“…A further study compared the improvement of 15 HS patients treated with oral acitretin 0.5 mg/kg body weight with patients receiving the same acitretin dose followed by wide surgical excision. The recurrence rate was lower (20 %) in the group of patients with oral acitretin plus surgical excision as compared with those (40 %) who took only oral acitretin [73]. Acitretin can be used in early stages of the disease (Hurley I or mild II) and in the chronic stages with recurrent abscesses with sinus tracts and/or scarring.…”

North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations

“…[28][29][30][31][32][33]103 The mean dose ranged from 0.5 to 1 mg/kg/d, with the mean duration ranging from 4 to 10 months. Hurley stages were mostly unreported and outcome measures varied Rifampin 1 clindamycin B II [10][11][12][13][14][15][16] Rifampin 1 moxifloxacin 1 metronidazole C II 17 Dapsone C III 18,19 Ertapenem C III 20,21 Hormonal therapies Antiandrogen contraceptives C II 22,23 Spironolactone C III 24 Metformin C III 25 Finasteride C III 26 Retinoids Isotretinoin B II [27][28][29][30][31][32] Acitretin B II [33][34][35][36] Alitretinoin B II 37 Systemic immunomodulators Methotrexate Not recommended III 38 Azathioprine Not recommended III 39 Colchicine C (in combination with minocycline only) III 9,40 Cyclosporine C III [41][42][43][44][45] Systemic steroids C* III 46,…”

“…Three cohort studies and 1 small RCT (acitretin vs acitretin and wide excision) of mostly patients with Hurley stage II to III disease have been reported, for a total of 50 patients. [33][34][35][36] The typical dose was 0.5 or 0.6 mg/kg/d, with the mean duration ranging from 3 to 12 months. Validated outcome measures were lacking, but 54% of patients reported improvement.…”

Hidradenitis suppurativa/acne inversa: a practical framework for treatment optimization – systematic review and recommendations from the HS ALLIANCE working group

“…Systemic acitretin may be considered as a third-line therapy for patients with mild/moderate HS [35][36][37][38] (evidence level 4, grade of recommendation C).…”