Pharmacologic interventions for hidradenitis suppurativa: what does the evidence say?
BACKGROUND
Hidradenitis suppurativa is a chronic debilitating skin disease that is recalcitrant to treatment.


OBJECTIVE
The aim of this article was to conduct an evidence-based review of pharmacologic interventions for the treatment of hidradenitis suppurativa (HS).


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Division of Dermatology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. raed.alhusayen@sunnybrook.ca
Raed
R
Alhusayen
Neil H
NH
Shear
D000726:Androgen Antagonists / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003879:Dermatologic Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D017497:Hidradenitis Suppurativa / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D000069285:Infliximab; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000726:Androgen Antagonists; D000900:Anti-Bacterial Agents; D000911:Antibodies, Monoclonal; D003879:Dermatologic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab