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

Abstract

An inappropriate immunological response to an unknown antigen has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Studies have identified elevated levels of several proinflammatory cytokines, including interleukin (IL)-17A and tumour necrosis factor-α, nominating these as possible therapeutic targets. Secukinumab is an IL-17A monoclonal antibody, which binds to IL-17A and inhibits the cytokine interaction with the IL-17 receptors, inhibiting the inflammatory cascade. Here we report a case of a 47-year-old man, with Hurley stage III lesions on the neck, axillae, breasts, genital skin and buttocks, who had experienced only temporary benefit from different medical treatments over several years. After 12 weeks of treatment with secukinumab, the number of lesions reported by the patient within the period of the last 4 weeks was reduced from 23 to seven, his pain visual analogue scale (VAS) score was reduced from 5 to 3 and pain/utility/handicap VAS score was reduced from 7 to 4. These results may be taken to imply that IL-17 blockade could provide a possible therapeutic approach in the treatment of HS.

Development of HiSQOL: A Hidradenitis Suppurativa-Specific Quality of Life Instrument

“…Dermatologic-specific questionnaires, such as DLQI [13], do include more of these dimensions, but still, many of the items identified in this study are not represented. As a result, it is possible that an HS patient can experience a meaningful improvement in his or her perceived QOL following a given intervention, without this improvement being reflected in, e.g., an improved DLQI score [21]. A HS-specific instrument, in contrast, has the potential of being more sensitive to change.…”

T helper 17 cell/regulatory T-cell imbalance in hidradenitis suppurativa/acne inversa: the link to hair follicle dissection, obesity, smoking and autoimmune comorbidities

“…Of the IL‐17 neutralizing monoclonal antibodies seculinumab, ixekuzumab and brodalumab, only seculinumab has been approved for the treatment of psoriasis and psoriatic arthritis . It has recently been reported that HS exhibits a clinical response to seculinumab . Current therapeutic efforts focus on attenuating IL‐17 signalling in HS …”

“…[217][218][219] It has recently been reported that HS exhibits a clinical response to seculinumab. 220,221 Current therapeutic efforts focus on attenuating IL-17 signalling in HS. 133,222,223…”

Enduring support for the case report

“…For example, biologics potentially provide rich pickings for repurposing as the field of proteomics uncovers new disease processes. The recent report of secukinumab used for the first time in severe hidradenitis suppurativa based on the role of interleukin‐17A in the disease is such an example . Similarly, the first report of liraglutide, a glucagon‐like peptide‐1 agonist with anti‐inflammatory and weight reducing properties, used in severe hidradenitis is another .…”