Hidradenitis suppurativa (HS): An unrecognized paradoxical effect of biologic agents (BA) used in chronic inflammatory diseases

Abstract

Paradoxical hidradenitis suppurativa (HS) induced by biologic agents (BA) is scarcely reported. We sought to describe the clinical characteristics and outcome of patients developing paradoxical HS under BA. This was a multicenter nationwide retrospective study asking physicians to report all cases of HS, confirmed by a dermatologist, occurring during treatment of an inflammatory disease by a BA. We included 25 patients (15 inflammatory rheumatism, 9 Crohn's disease, 1 psoriasis) treated by 5 BA (adalimumab=12, infliximab=6, etanercept=4, rituximab=2, tocilizumab=1). Median duration of BAexposure before HS onset was 12 (range 1-120) months. Patients were mostly Hurley stage I (n=13) or II (n=11). Simultaneously to HS or within 1year, 11 patients developed additional inflammatory diseases, including paradoxical reactions (psoriasis=9, Crohn's disease=3, alopecia areata=1, erythema elevatum diutinum=1). Complete improvement of HS was more frequently obtained after BA discontinuation or switch (n=6/10, 60%) rather than maintenance (n=1/14, 7%). Reintroducing the same BA resulted in HS relapse in 3 of 3 patients. Retrospective nature and lack of complete follow-up for some patients are limitations. HS is a rare paradoxical adverse effect of BA, but fortuitous association cannot be excluded in some cases. We observed a trend toward better outcome when the BA was discontinued or switched.