Non-pharmacologic approaches for hidradenitis suppurativa – a systematic review

Abstract

Importance: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition presenting with painful nodules and sinus tracts primarily in intertriginous regions. The persistent nature of HS and challenges in symptom management lead many patients to seek non-pharmacologic approaches due to the paucity and limited efficacy of conventional HS therapeutic options.

Objective: To evaluate the existing evidence for non-pharmacologic modalities in treatment of HS.

Findings: Discussed in this review are non-pharmacologic modalities with evidence of efficacy in HS treatment, including weight loss, vitamin B12, vitamin D and zinc supplementation, and dietary avoidance of brewer’s yeast. Limitations of the available data on non-pharmacologic therapies in HS include the predominance of pilot and single-armed studies, as well as heterogeneity in study design, subject disease severity, concomitant treatment and comorbid conditions.

Conclusions and relevance: HS patients are becoming increasingly interested in the use of non-pharmacologic approaches to augment conventional treatments. Strength of evidence for non-pharmacologic therapies in HS is limited by small study size and lack of randomized controlled trials. Future large-scale investigations should be pursued to better establish efficacy and dosing regimens for the use of non-pharmacologic treatments in HS.

Keywords:

• Hidradenitis suppurativa
• acne inversa
• Verneuil’s disease
• non-pharmacologic
• wound care
• hygiene
• weight loss
• smoking cessation
• diet

Disclosure statement

VYS is a stock shareholder of Dermveda, has served as an advisor for Sanofi Genzyme/Regeneron, AbbVie, Novartis, SUN Pharma, Pfizer, Menlo Therapeutics, Burt’s Bees, GpSkin, the National Eczema Association and Global Parents for Eczema Research, is an investigator for AbbVie, Regeneron, Novartis, and LEO Pharma, and has received research funding from the Foundation for Atopic Dermatitis and Skin Actives Scientific. There were no incentives or transactions financial or otherwise relevant to this manuscript.

AJH, PAH, SS, ARV, HAL and JLH have no conflicts of interest to declare relevant to this manuscript.