Current systemic treatment strategies for hidradenitis suppurativa

ABSTRACT

Introduction: Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating disease of a relapsing nature involving nodules, abscesses and suppurating lesions of intertriginous areas of the skin. Within recent years there has been a progress in terms of the treatment of hidradenitis suppurativa, nevertheless its therapy still remains limited with very few effective options.

Areas covered: This article provides a review of current systemic treatment strategies used in patients with hidradenitis suppurativa – from well-established, traditional methods to new therapeutic alternatives with special focus on biological agents.

Expert opinion: The etiology of hidradenitis suppurativa is still not clearly explained, but several factors seem to play a role such as genetics, smoking and obesity. Recent findings have specified that HS is a disease of the hair follicles with bacterial infection and apocrine glands involvement as secondary events. In HS treatment all known pathomechanisms underlying and responsible for development of skin lesions should be taken into account, including hyperkeratinization and occlusion of pilosebaceous unit, bacterial superinfection and extensive, chronic inflammatory response. Thus, retinoids, systemic antibiotics and biologics should be agents of special interest. Summarizing, pharmacological therapies are promising option for HS sufferers, especially in non-advanced cases.

KEYWORDS:

• Hidradenitis suppurativa
• treatment
• systemic
• review

Article highlights

• Current pharmacological management of hidradenitis suppurativa (HS) still offers a limited number of effective therapeutic options.

• Due to lack of large, good quality randomized controlled trials or prospective clinical studies on HS medical treatment (except of PIONEER studies) the therapeutic approach is mainly based on experts’ opinions with ‘approval’ of antibiotics, retinoids and immunomodulators.

• Long-term treatment with systemic antibiotics (incl. tetracyclines or combination of rifampicin and clindamycin) is used to control chronic inflammation and usually serves as first-line therapy due to their general availability are relative cheapness.

• The only approved drug by regulatory agencies is adalimumab, with other biologics requiring more rigorous evaluation before any recommendations for their wider usage could be finally established.

• The medical therapies are promising option for HS sufferers, especially in non-advanced cases, however they should be administered as early as possible – just to avoid irreversible consequences of fully developed disease, which are much more suitable for surgical intervention.

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Declaration of interest

L Matusiak and J Szepietowski have acted as speaker and on advisory boards for Abbvie. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Additional information

Funding

This paper was not funded.