Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that causes a significant decline in quality of life. There are numerous treatment options; however, real‐life data on the efficacy of these treatments is limited. This study was performed in two centers to describe clinical characteristics and assess treatment outcome in a cohort of 139 patients with HS. Data on demographic and clinical characteristics, Hurley stage and comorbidities were collected from patient charts and evaluated retrospectively. Treatment response was measured with HS clinical response index (HISCR). Mean body mass index was 27.8±4.88. Inflammatory comorbidities were present in 23%. Among first‐line drugs systemic doxycycline resulted in 60% HISCR followed by rifampicin–clindamycin combination (46.4%). Isotretinoin had the lowest HISCR (30.7%) in this group. For second‐line therapies, all acitretin treated patients achieved response and patients treated with tumor necrosis factor alpha (TNF‐α) inhibitors had the highest HISCR. Currently recommended first‐line therapies have moderate efficacy in HS. Acitretin appears to be a reasonable alternative for the highly effective TNF‐α inhibitors in patients with severe and resistant HS. Overall, these results support that excessive inflammatory response play an important role in pathogenesis of HS.

Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity

“…reported that follicular occlusion diseases, pilonidal cysts, sebaceous cysts, dissecting cellulitis of the scalp, acne conglobata and other acne forms were more prevalent in patients with HS. Consistent with our findings, in a previous study of 128 Turkish patients with HS, Vural et al 12 . reported that acne vulgaris (23%, n = 32) and acne conglobata (8.6%, n = 12) were the most common cutaneous comorbidities.…”

“…Male sex, obesity, disease duration, smoking packyears and the location of the lesions (axillary, perianal and mammary) have been suggested as risk factors in previous studies. 12 We found a mean diagnostic delay of 5.8 AE 9.91 years, which is shorter than that reported by a previous study (7.2 AE 8.7 years). 24 Identification of a delay in diagnosis as a severity risk factor suggests that late diagnosis is a substantial factor in the development of severe HS.…”

“…Yuksel and Basim 3 reported that male sex, low education level, groin involvement, high BMI and absence of acne were associated with severe disease stages in their study of 208 Turkish patients with HS. Male sex, obesity, disease duration, smoking pack‐years and the location of the lesions (axillary, perianal and mammary) have been suggested as risk factors in previous studies 12 …”

The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study

“…12 More recently, HiSCR response was assessed in a retrospective case series of patients treated with systemic doxycycline 100mg b.i.d, with 60% of patients achieving HiSCR after 12 weeks of treatment. 14 This is markedly higher than the 40.1% HiSCR attainment found in the tetracycline group in our study. However, no baseline AN-count was reported by Vural et al, which is known to influence HiSCR attainment, and the included population may not be comparable to our study.…”

“…12 The efficacy of clindamycin and rifampicin combination therapy is derived from several small retrospective and prospective case series. [13][14][15][16][17][18][19][20][21][22] Therefore, the aim of this multicenter, international study was to assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin using validated and clinically meaningful physician and patient reported outcomes in patients with HS. In addition, we aimed to identify factors associated with treatment response.…”