Radiation Therapy for Chronic Hidradenitis Suppurativa

Abstract

Background: Hidradenitis suppurativa is a chronic follicular occlusive disease in apocrine gland-bearing regions. Frequently refractory to conventional oral and topical treatments, it may require surgical intervention. Objective: To investigate the effectiveness of radiation therapy for refractory hidradenitis suppurativa. Methods and materials: Five patients with refractory Hurley stage II/III hidradenitis suppurativa were treated with radiation therapy to 13 affected sites. Electron beam radiation to a total dose of 7.5 gray was applied over 3 consecutive days. Results: The mean age of patients was 45 years; 80% had hidradenitis suppurativa for ≥ 6 years. Three patients had Hurley stage III; 2 had Hurley stage II. All had been treated previously with topical and oral antibiotics and other therapies, including surgery, radiation therapy, Nd:YAG laser therapy, and infliximab. No complete responses were observed, but 53% of the lesions had a partial response. Lesions in the axilla, gluteal, and inguinal areas had response rates of 100%, 67%, and 50%, respectively, compared to 0% for perineal lesions. Conclusions: Radiation therapy may be a promising treatment for refractory hidradenitis suppurativa. A prospective study is warranted to further evaluate response rates, define optimal dose fractionation schedules, and better understand the risk of long-term toxicity.