An Update on Medical Treatment Options for Hidradenitis Suppurativa

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by recurrent inflammatory nodules mostly located in the armpits and groin. Over the years multiple treatments for HS have been proposed; however, to date a cure is still lacking. In this update we provide an overview of most drug treatments reported on for HS, where possible with their mode of action and side effects. In mild cases, clindamycin lotion or resorcinol cream have proven effective. Tetracyclines are a first-line systemic option in more widespread or severe cases, followed by the combination of clindamycin and rifampicin. However, the recurrence rate is high after discontinuation of clindamycin plus rifampicin combination therapy. Long-term treatment with retinoids, especially acitretin is feasible, although teratogenicity has to be taken into account in females of reproductive age. Multiple antiinflammatory drugs have been suggested for HS, such as dapsone, fumarates or cyclosporine. However, their effectiveness in HS is based on small case series with varying results. If most common treatments have failed, biologics (e.g., infliximab or adalimumab) are the next step. Although not addressed in this review, surgical interventions are often needed to achieve remission. Key PointsHidradenitis suppurativa (HS) is a chronic inflammatory skin disease without a cure.Antibiotics (topical or oral) are often the first treatment option for HS.In cases of more extensive or therapy-resistant HS, biologicals (e.g., infliximab or adalimumab) are a good therapeutic option.

Bacterial biofilm in chronic lesions of hidradenitis suppurativa

“…). The first choice of treatment in HS is antibiotics such as clindamycin and tetracycline (topical and systemic) . Although these drugs also have an effect on the immune system (T cells) over time, they usually yield good efficacy initially.…”

Biofilm production and antibiotic susceptibility of Staphylococcus epidermidis strains from Hidradenitis Suppurativa lesions

“…40 Treatment of HS is mainly based on immunomodulatory and anti-inflammatory therapy, and not on the bacteriocidal of bacteriostatic effect of antibiotics. 18 Therefore, our findings regarding the antibacterial effect on our strains are of less importance in the treatment of HS, although it has profound importance when considering the escalating problems tied to antimicrobial resistance.…”

“…The current concept of HS treatment is immunomodulatory and anti‐inflammatory therapy, and the antibiotics commonly used to treat HS possess those properties …”

“…16,17 The current concept of HS treatment is immunomodulatory and anti-inflammatory therapy, and the antibiotics commonly used to treat HS possess those properties. 18 Therefore, we aimed to characterize the in vitro antibiotic susceptibility pattern, the in vitro growth and biofilm-forming capabilities of S. epidermidis strains isolated from HS patients.…”

An Atypical Localized Form of Hidradenitis Suppurativa of the Jawline and Neck Mimicking Severe Cystic Acne on Presentation

“…Closed comedones are present in the latter and absent in the former, while the rope-like bridged scars are typical of HS and are different from the common hypertrophic or keloidal acne scars [3]. Thus, the clinical appearance of the lesions, the lack of response to isotretinoin, and a satisfactory response to adalimumab, one of the biologics with the strongest evidence to treat HS [4], allowed us to conclude that this patient has a localized form of HS involving an atypical location, instead of a severe type of acne. Moreover, the involvement of atypical locations such as the anterior neck and jawline (areas with an abundant number of terminal hair follicles) in this case supports another possible pathogenic theory of HS, which consists of the occlusion of terminal hair follicles rather than to be essentially a disorder of the apocrine glands [5,6,7].…”