A Systematic Review of Treatments for Hidradenitis Suppurativa

Rambhatla, Pranita V.; Lim, Henry W.; Hamzavi, Iltefat

doi:10.1001/archdermatol.2011.1950

Cited by 81 publications

(9 citation statements)

References 71 publications

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“…22 For patients with more extensive and/or refractory HS (Hurley stage III), conventional medical therapies have proven less effective, and radical resection of all involved tissue may offer the only potential option for a cure (Table 4). 13,16,23 Nevertheless, high rates of recurrence and disease progression after wide local excision have led investigators to seek alternative treatment strategies and therapeutic combinations.…”

Section: Discussionmentioning

confidence: 99%

Outcomes After Combined Radical Resection and Targeted Biologic Therapy for the Management of Recalcitrant Hidradenitis Suppurativa

DeFazio

Economides

King

et al. 2016

Annals of Plastic Surgery

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Background Trials demonstrating the efficacy of biologic therapy for moderate to severe hidradenitis suppurativa (HS) have inspired new multidisciplinary treatment strategies. We present our experience with combined biologic and surgical therapy for recalcitrant HS. Methods Between 2011 and 2014, 21 patients (57 cases) with Hurley Stage III HS underwent radical resection with delayed primary closure alone, or in combination with adjuvant biologic therapy. Demographic data, treatment regimen, outcomes, and complications were retrospectively reviewed for all cases. Results Eleven patients underwent combined surgical and biologic therapy, whereas radical resection alone was performed in 10 patients. The average soft tissue deficit, before closure, for the combined and surgery-only patients was 56 cm2 and 48.5 cm2, respectively (P = 0.66). Biologic agents including infliximab (n = 8) and ustekinumab (n = 3) were initiated 2 to 3 weeks after closure and were continued for an average of 10.5 months. Recurrence was noted in 19% (4/29) and 38.5% (10/26) of previously treated sites for combined and surgery-only patients (P < 0.01). For the combined cohort, the disease-free interval was approximately 1 year longer on average (P < 0.001); however, this difference was reduced to 4.5 months when considering time to recurrence after cessation of biologic therapy (P = 0.09). New disease developed in 18% (2/11) and 50% (5/10) of combined and surgery-only patients, respectively (P < 001). No adverse events were noted among patients who received biologic therapy. Conclusions Lower rates of recurrence and disease progression, as well as a longer disease-free interval may be achieved with the use of adjuvant biologic therapy after radical resection for recalcitrant HS.

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Section: Discussionmentioning

confidence: 99%

Outcomes After Combined Radical Resection and Targeted Biologic Therapy for the Management of Recalcitrant Hidradenitis Suppurativa

DeFazio

Economides

King

et al. 2016

Annals of Plastic Surgery

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“…Surgical studies with classical evidenced-based evaluation of efficacy are generally sparse [23]. In agreement with the evidence paradigm of surgery, only large case series and studies reporting recurrence rates and a follow-up period of at least 1-year were therefore included in the evaluation.…”

Section: Methodsmentioning

confidence: 99%

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Gulliver

Zouboulis

Prens

et al. 2016

Rev Endocr Metab Disord

194

288

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Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patients should be offered adjuvant therapy as needed (pain management, weight loss, tobacco cessation, treatment of super infections, and application of appropriate dressings). The treating physician should be familiar with disease severity scores, especially Hurley staging, physician global assessment and others. The routine use of patient’reported outcomesincluding DLQI, itch and pain assessment (Visual Analogue Scale) is strongly recommended. The need for surgical intervention should be assessed in all patients depending upon type and extent of scarring, and an evidence-based surgical approach should be implemented. Evidence-based medical treatment of mild disease consists of topical Clindamycin 1 % solution/gel b.i.d. for 12 weeks or Tetracycline 500 p.o. b.i.d. for 4 months (LOE IIb, SOR B), for more widespread disease. If patient fails to exhibit response to treatment or for a PGA of moderate-to-severe disease, Clindamycin 300 p.o. b.i.d. with Rifampicin 600 p.o. o.d. for 10 weeks (LOE III, SOR C) should be considered. If patient is not improved, then Adalimumab 160 mg at week 0, 80 mg at week 2; then 40 mg subcutaneously weekly should be administered (LOE Ib, SOR A). If improvement occurs then therapy should be maintained as long as HS lesions are present. If the patient fails to exhibit response, then consideration of second or third line therapy is required. A growing body of evidence is being published to guide the treatment of HS. HS therapy should be based upon the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines. Treatment should include surgery as well as medical treatment. Future studies should include benefit risk ratio analysis and long term assessment of efficacy and safety, in order to facilitate long term evidence based treatment and rational pharmacotherapy.

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“…As discussed previously, the treatment options for HS are limited and none have proven to be dramatically effective [4]. Few of the biologics and surgery have shown Although it appears logical to assume that inflammation of apocrine glands is the primary event in HS as the lesions are distributed mainly in apocrine rich locations, some improvement, but are associated with a high rate of adverse events.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional surgical intervention has been excision of the affected areas with variable recurrence rates and high associated morbidity. Newer approaches include the CO 2 and Nd:YAG lasers both with promising results [4].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Nd:YAG Laser for the Treatment of Hidradenitis Suppurativa

Nosrati¹,

Hunter²,

Kelly³

2012

JCDSA

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Hidradenitis suppurativa (HS) is an inflammatory skin disease that involves sebaceous glands and hair follicles of intertriginous areas, including axillary and inguinal regions. It is often chronic, painful, disabling, and can worsen over time. Besides surgically excising affected areas, effective treatments are currently lacking. The long-pulsed neodymium:yttrium-aluminium-garnet (Nd:YAG) laser is a device that has traditionally been used for hair removal, but has recently shown promise in clearing old lesions of HS and preventing new eruptions. In accordance with studies in the current literature, we hypothesize that the Nd:YAG laser will significantly improve subjects with hidradenitis suppurativa compared to standard, uninvasive treatment with topical antibiotics [1,2]. Study aims include: to treat subjects with hidradenitis suppurativa with Nd:YAG laser therapy once monthly for 3 consecutive months, with a one month followup; to compare the effectiveness of Nd:YAG treatment on one side of the subject (e.g., right) to treatment with topical antibiotics on the subject's other side (e.g., left); to assess treatment response using a visual analogue scale; to assess subject satisfaction with treatment using a questionnaire; and to photodocument treatment response at each visit.

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A Systematic Review of Treatments for Hidradenitis Suppurativa

Cited by 81 publications

References 71 publications

Outcomes After Combined Radical Resection and Targeted Biologic Therapy for the Management of Recalcitrant Hidradenitis Suppurativa

Outcomes After Combined Radical Resection and Targeted Biologic Therapy for the Management of Recalcitrant Hidradenitis Suppurativa

Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Efficacy of Nd:YAG Laser for the Treatment of Hidradenitis Suppurativa

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