A Review of Syndromic Hidradenitis Suppurativa Treatment

BackgroundCase series have indicated that intravenous antibiotics may be effective in severe hidradenitis suppurativa (HS) treatment. This treatment approach is excluded from the British Association of Dermatologists UK HS treatment guidelines but can be found in the European S2k, North American and French Dermatology Society HS guidelines.ObjectivesTo study whether intravenous antibiotics are being used in HS treatment in the UK and to explore the experiences of dermatologists and outpatient parenteral antibiotic therapy (OPAT) teams with intravenous antibiotics.MethodsTwo separate surveys were distributed to dermatologists and OPAT centres respectively in 2020. The surveys were designed on Survey Monkey® with skip logic and free text boxes incorporated. Only UK responses were included. Descriptive and content analyses were performed on the data.ResultsSeventy-four dermatology clinicians and 25 OPAT centres responded. Nearly half of the respondents reported having treated HS with intravenous antibiotics. Most used intravenous ertapenem for an average treatment duration of 4–6 weeks with 1–3 months of average remission period. Top indications were severe disease (57%) and biologic treatment failure (57%). The most common consolidation treatments were biologics, surgery and tetracycline antibiotics. A joint dermatology–OPAT HS clinic was preferred. Dermatologists reported exclusion of intravenous antibiotics from local/national guidelines (67%) being the main barrier to using intravenous antibiotics.ConclusionFindings from the two surveys show overall positive experience using intravenous antibiotics in HS treatment and call for development of a best practice statement in HS treatment with intravenous antibiotics and collaborative working with OPAT for a national referral pathway.

Hidradenitis suppurativa in acute myeloid leukemia: Review of disease course and management

The treatment of hidradenitis suppurativa (HS) has always been a real challenge for dermatologists; to date, adalimumab the only biologic drug approved for HS is adalimumab, an anti-tumor necrosis factor (TNF)-α drug, the approval of this drug dates to 2015, data provided by real life show an effectiveness rate of about 60% percent. Recently (31 October 2023) FDA approves secukinumab for moderate-severe HS. The treatment and management of HS is very challenging as available treatments are very limited and show very variable outcomes. We conducted a prospective monocentric study designed to evaluate the efficacy and safety of secukinumab treatment in HS patients in a real-life setting. The initial cohort of patients recruited included 21 HS patients including 12 females and 9 males. About 57.1% of patients achieved the primary endpoint and recorded significant decrease in all the severity assessment scales (IHS4, DLQI and VAS pain scale) at week 16 and 52, when HiSCR reached 71.4%. The results of our study highlight that treatment with secukinumab in patients with severe HS who failed adalimumab may be a safe and effective therapeutic weapon.

Hidradenitis suppurativa is a chronic debilitating skin disease that is recalcitrant to treatment. The aim of this article was to conduct an evidence-based review of pharmacologic interventions for the treatment of hidradenitis suppurativa (HS). A systematic search of MEDLINE, EMBASE, and the Cochrane database was conducted to identify controlled trials (randomized controlled trials, cohorts, and case-control studies) published in English. The abstracts were examined using predetermined inclusion and exclusion criteria. The identified studies were used to develop the recommendations. Clinically relevant outcomes that were assessed were: clinical remission, patient global assessment, physician global assessment, number of skin lesions, and improvement in Hurley's stage, or Sartorius score. Overall there was sparse evidence to support the use of any treatment modality. There is fair evidence to support the use of antibacterials in HS and they should be used as first-line therapy (level II-1/grade B). There is fair evidence to support the use of intravenous infliximab in the treatment of advanced HS (Hurley's stage II and III). Given the high cost of anti-tumor necrosis factor therapy and its adverse-effect profile, intravenous infliximab should be offered to patients with severe disease affecting their daily activities who have failed antibacterial therapy (level I/grade B). There is insufficient evidence to support the use of antiandrogens in HS; consideration could be given to their use in women with mild to moderate disease (Hurley's stage I and II) who have failed antibacterial therapy and women with an abnormal hormone profile (level II-2/grade I). The existing evidence suggests that antibacterials and anti-tumor necrosis factor therapy are effective in the treatment of HS. Further research is required to confirm the efficacy of the different medications within these groups and to explore the efficacy of other treatment modalities.

33431 Efficacy of 80 mg/week dose of adalimumab (Humira) in treatment of hidradenitis suppurativa

The coexistence of hidradenitis suppurativa (HS) and acne fulminans (AF) has only recently been reported in the literature. We present a case of a 17-year-old man who presented with a 2 years history of severe acne and HS. He was initially started on oral clindamycin and rifampicin for 3 months with no clinical improvement. Acne lesions became worse with the presence of nodules and necrotic ulcers, while weight loss, low-grade fever, back and knee pain, and psychological distress were noted. We prescribed adalimumab in its standard dosing regimen. Remission of AF was achieved in 3 months, whereas adalimumab has not been as effective in treating the HS lesions. Its dosage was increased to 80 mg weekly and more than 80% clinical improvement of HS lesions was obtained in 2 months. The patient maintained on this dosage till this day and efficacy is sustained. TNF-α inhibitors are considered an effective option in the treatment of HS, while it has been also suggested as a treatment option in AF. Our patient was successfully treated with adalimumab. Since the coexistence of HS and AF has a devastating emotional effect on the patient, there is an urgent need to implement therapeutic approaches.

Trimethoprim/sulfamethoxazole and cephalexin combination therapy in hidradenitis suppurativa patients: A series of 16 cases

Reduced risk of suicidal behaviours associated with the treatment of hidradenitis suppurativa with tumour necrosis factor alpha antagonists: results from the US FDA Adverse Events Reporting System pharmacovigilance database.

Introduction: Treatment of hidradenitis suppurativa (HS) is challenging, and in Hurley stage I, it is based on topical measures. Our aim was to compare the efficacy and safety of topical resorcinol 10% with topical clindamycin 1% and no therapy, in Hurley stage I HS. Methods: In this open, prospective, randomized trial, we studied 60 Hurley stage I patients with IHS4 ≤10. Group A was treated with topical resorcinol 10%; group B with clindamycin lotion 1%; and group C received no treatment. Patients were evaluated by total lesion count, the International Hidradenitis Suppurativa Severity Score System (IHS4) and the Dermatology Life Quality Index (DLQI) at baseline, 12 and 24 weeks. Self-reported number of flares and adverse events (AEs) were recorded. Results: A significant reduction in the mean total lesion count and DLQI scores were observed in group A, compared to group B at week 12 (p = 0.036, p < 0.001, respectively), and in the mean total lesion count, IHS4, and DLQI scores at week 24 (p = 0.034, p = 0.017, p < 0.001, respectively). Resorcinol 10% was well-tolerated with only mild AEs. Conclusion: Resorcinol 10% may represent a useful alternative for the long-term treatment of mild HS, which is superior to topical clindamycin and has a favorable safety profile.

Hidradenitis suppurativa (HS) and atopic dermatitis (AD) are chronic inflammatory cutaneous disorders associated with psychosocial distress. The stigma of HS and AD often creates a burden on patients, leading to a negative self-image and higher rates of anxiety and depression.1-3 However, few studies investigate the general public's endorsement of stigmatizing attitudes towards people with cutaneous diseases.4, 5 We aimed to analyze the perception towards individuals with HS and AD and evaluate factors leading to higher rates of stigmatization. A 51-question survey was distributed to subjects over the age of 18 on the online survey recruitment platform Amazon Mechanical Turk (MTurk). To improve survey reliability, a series of four screening questions testing participants' attentiveness were randomly embedded throughout the survey. Patients were ineligible for the study if they answered one of the screening questions incorrectly. The survey displayed two images each of moderate-to-severe HS and AD and then examined participants' attitudes towards these images. The questions measuring stigma were separated into three categories based on previous studies4, 5: Desire to Social Distance, Stereotype Endorsement and Belief in AD Myths. Each question was scored on a 1–5 Likert scale, with 1 being the most stigmatizing attitude and 5 the least. Responses that were scored as a 1 or 2 were considered as the endorsement of stigmatizing attitudes when completing statistical analysis. Fisher's exact test was used to compare differences in attitudes towards patients with HS versus AD, and patients currently affected or with a history of HS/AD versus those with no history of HS/AD. A total of 497 participants responded to the survey, of which 350 answered the screening questions correctly (70% response rate, Table 1). Participants reported not feeling comfortable hiring someone with HS and AD (17.4% vs. 18.3%, p = 0.8), believing patients with HS and AD have poor hygiene (27.7% and 28.0%, p = 0.9) and endorsed the myth that people with HS and AD are to blame for their condition (64.3% vs. 64.6%, p = 1.0, Table 2). There was a minimal difference in the stigma towards individuals with HS versus AD. Survey respondents had more stigmatizing attitudes towards wanting to date an individual with AD compared to HS (mean Likert score 3.49 vs. 3.68, p = 0.03), and this was the only statistically significant difference when comparing average Likert scores towards individuals with HS versus AD. Participants not currently affected or without a history of HS or AD had more stigmatizing attitudes compared to individuals with a history of HS or AD (p < 0.0001, Table 2). Patients with HS and AD often experience reduced quality of life, which is in part due to the perceived stigma of having cutaneous disease. Our study is limited by self-reported outcomes recorded via MTurk crowdsourcing software. Still, the findings set the foundation for future research on the negative biases towards patients with HS and AD. Moreover, participants with a history of HS or AD were less likely to have stigmatizing viewpoints towards HS and AD individuals. Increasing health education initiatives directed toward the general public on the causes and treatments for HS and AD may reduce the stigma of these cutaneous diseases. Study conception and design: Jonathan D. Greenzaid, Matthew C. Johnson and Steven R. Feldman. Data collection: Jonathan D. Greenzaid and Matthew C. Johnson. Analysis and interpretation of results: Jonathan D. Greenzaid, Matthew C. Johnson and Steven R. Feldman. Draft manuscript preparation: Jonathan D. Greenzaid. All authors reviewed the results and approved the final version of the manuscript. S. R. F. has received research, speaking and/or consulting support from Eli Lilly and Company, GlaxoSmithKline/Stiefel, AbbVie, Janssen, Alovtech, vTv Therapeutics, Bristol-Myers Squibb, Samsung, Pfizer, Boehringer Ingelheim, Amgen, Dermavant, Arcutis, Novartis, Novan, UCB, Helsinn, Sun Pharma, Almirall, Galderma, Leo Pharma, Mylan, Celgene, Ortho Dermatology, Menlo, Merck & Co, Qurient, Forte, Arena, Biocon, Accordant, Argenx, Sanofi, Regeneron, the National Biological Corporation, Caremark, Teladoc, BMS, Ono, Micreos, Eurofins, Informa, UpToDate and the National Psoriasis Foundation. He is founder and part owner of Causa Research and holds stock in Sensal Health. The remaining authors declare no conflicts of interest. Reviewed and approved by Wake Forest University Health Sciences IRB IRB00075066. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

33431 Efficacy of 80 mg/week dose of adalimumab (Humira) in treatment of hidradenitis suppurativa

Background / Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that most often affects apocrine gland-bearing areas of the skin. The treatment depends on the severity of the clinical presentation. The paper objective was to present new modalities in management and treatment of HS. Methods: The subjects in this research included the patients suffering from the severe form of HS, who were treated in the University Clinical Centre of the Republic of Srpska for the past three years. The effect of treatment of HS were monitored. In four patients, biologic therapy with adalimumab or adalimumab biosimilars was administered, while four patients received radiotherapy and 17 of them, were treated surgically. Depending on the type of treatment, the effects of therapy were monitored after 6-12 weeks by using clinical examination and by assessing the disease stage according to the Hurley staging. Due to a small number of subjects, especially in patients treated with biologic and radiotherapy, it was not possible to perform any statistical analysis and the results were presented by description, in tables and photographs. Results: Biologic therapy: Adalimumab was administered subcutaneously 80 mg, twice a month. After 12 weeks, in 4 patients was observed a regression of changes by 60-70 % when compared to previous skin changes. Radiotherapy: the total radiation dose was 5 Gy, distributed in 5 or 10 fractions. After 12 weeks an improvement by 60-70 % was observed. Surgical treatment: after 6-8 weeks, the patients were fully recovered. Conclusions: Application of biologic and radiotherapy after 12 weeks had similar results, ie it brought to regression of changes by 60-70 %. The best results were achieved after surgical treatment of HS.

Patient perspectives on diagnosis and management of hidradenitis suppurativa: A web-based survey

Hidradenitis suppurativa (HS) is a complex disease with a dramatic impact on the quality of life of patients that it afflicts. Despite this, there are few treatment options offering long-term relief. The exact pathophysiology of HS is unclear, although the current theory involves follicular obstruction, rupture, and subsequent inflammation leading to fistula and abscess development in intertriginous skin. Several inflammatory modulators have been implicated in the development of HS, including tumor necrosis factor (TNF)-α as well as interleukin (IL)-1β, IL-10, and IL-17. Initial evidence for the use of TNF-α inhibitors in HS stemmed from recognition that inflammatory bowel disease patients treated with these medications saw a concurrent improvement in their HS symptoms. Early case reports and case series illustrated TNF-α inhibitors’ value in the treatment of HS. Later, two phase III clinical trials, PIONEER I and PIONEER II, demonstrated that adalimumab is an efficacious treatment for HS. Infliximab represents another effective HS treatment option with its main advantage being dosing flexibility. In contrast, clinical trials have failed to show evidence for application of etanercept in HS. There is limited data on other TNF-α inhibitors such as certolizumab-pegol and golimumab. This review outlines the history, dosing, response, and adverse effects of TNF-α inhibitors in the treatment of HS.

Hidradenitis suppurativa is a chronic inflammatory disorder that affects the skin. It causes recurring inflammatory lesions which may leave permanent scarring. The disease may be autoinflammatory. Hidradenitis suppurativa has been reported to emerge in patients with spondylarthritis, such as ankylosing spondylitis or psoriatic arthritis. The aim was to describe the case of a male patient who had psoriatic arthritis and developed hidradenitis suppurativa. A patient, male, aged 47 presented with psoriatic arthritis. He was on treatment with a TNFa inhibitor with good response as far as the arthritis was concerned. At the age of 51 he developed hidradenitis suppurativa with lesions in the axillary region bilaterally and under the lower ­mandible. Adalimumab was administered with partial remission of both psoriatic arthritis and hidradenitis suppurativa. However, as psoriatic arthritis was active in the axial skeleton with florid psoriasis and sacroiliitis was present bilaterally secukinumab 150 mg/month was initiated. Thereafter the dose of secukinumab was increased to 300 mg/month. Hidradenitis suppurativa lesions improved significantly. However, the pain in the axial skeleton remained intense. Hidradenitis suppurativa is a chronic inflammatory condition, which may be autoinflammatory in its pathogenesis. Hidradenitis suppurativa may appear in patients with spondylarthritis or psoriatic arthritis. Biologic agents are now applied in the management of hidradenitis suppurativa and appear to be effective. We describe the case of a patient with psoriatic arthritis and hidradenitis suppurativa who was treated effectively with biologic agents. The application of biologic agents in the treatment of hidradenitis suppurativa may shed light on the pathogenesis of the disease.