Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review
Abstract
:1. Introduction
2. Classification of Disease and Evaluation of Treatment Response
3. Treatment
3.1. General Recommendations
3.1.1. Smoking
3.1.2. Weight Reduction
3.1.3. Psychological Support
3.2. Medical Therapy
3.2.1. Topical and Intralesional Therapy
3.2.2. Systemic Therapies
Zinc Gluconate
Systemic Antibiotic Therapy
References | Study Design (Level of Evidence, Oxford Criteria [84]) | Treatment Regimen | Efficacy Data/Results |
---|---|---|---|
Tetracyclines | |||
Jemec et al., 1996 [85] | randomized double-blind trial (n = 46) (evidence level: 1b) | top. clindamycin (0.1%) b.i.d. vs. tetracycline 500 mg b.i.d. |
|
Vural et al., 2019 [86] | retrospective analysis of different HS treatments (n = 139) (evidence level: 4) | doxycycline 100 mg b.i.d. for 3 months |
|
Jørgensen et al., 2021 [70] | prospective follow-up study (n = 108) (evidence level: 2b) | tetracycline 500 mg b.i.d. (n = 32) vs. doxycycline 100 mg b.i.d. (n = 31) vs. lymecycline 300 mg b.i.d. (n = 45) median treatment duration: 3.2 months |
|
Armyra et al., 2017 [87] | prospective study/case series (n = 20) (evidence level: 4) | minocycline 100 mg q.d. + colchicine 0.5 mg b.i.d. for 3 months followed by colchicine 0.5 mg b.i.d. for 6 months |
|
Clindamycin–Rifampicin Combination Therapy | |||
Yao et al., 2021 [71] | prospective open-label study (n = 56) (evidence level: 4) | clindamycin 300 mg b.i.d. + rifampicin 300 mg b.i.d. for 10 weeks |
|
van der Zee et al., 2009 [73] | retrospective study (n = 34) (evidence level: 4) | clindamycin 600 mg b.i.d. + rifampicin 600 mg b.i.d. varying treatment duration (<10 weeks/>10 weeks) |
|
Gener et al., 2009 [72] | retrospective study (n = 116) (evidence level: 4) | clindamycin 300 mg b.i.d. + rifampicin 600 mg q.d. for 10 weeks |
|
Mendonça et al., 2006 [74] | retrospective study (n = 14) (evidence level: 4) | clindamycin 300 mg b.i.d. + rifampicin 300 mg b.i.d for 10 weeks |
|
Intensified Antibiotic Treatments | |||
Join-Lambert et al., 2016 [81] | retrospective study (n = 30) (evidence level: 4) | ertapenem 1 g iv. q.d. for 6 weeks followed by antibiotic consolidation treatment (rifampicin, moxifloxacin, metronidazole) | after 6 weeks (ertapenem):
|
Join-Lambert et al., 2011 [79] | retrospective study (n = 28) (evidence level: 4) | rifampicin 10 mg/Kg q.d. + moxifloxacin 400 mg q.d. + metronidazole 500 mg t.i.d. for 6 weeks *, followed by consolidation with rifampicin + moxifloxacin for ≥6 weeks |
|
Hormonal Treatment Approaches
References | Study Design (Level of Evidence, Oxford Criteria [84]) | Treatment Regimen | Efficacy Data/Results |
---|---|---|---|
Antiandrogen Treatments | |||
Kraft et al., 2007 [94] | retrospective chart review patients (n = 64, all female) (evidence level: 3b) | various antihormonal treatments (n = 29)
|
|
Sawers et al., 1986 [92] | case series (n = 4, all female) (evidence level: 4) | CPA 100 mg q.d. + ethinylestradiol 30–50 mg q.d. |
|
Mortimer et al., 1986 [93] | randomized double-blind crossover trial (n = 24, all female) (evidence level: 2b) |
|
|
Spironolactone | |||
Lee et al., 2015 [97] | case series (n = 20, all female) (evidence level: 4) | spironolactone 100–150 mg/d ± minocycline ± CPA |
|
Golbari et al., 2019 [96] | retrospective single-center chart review (n = 67, all female) (evidence level: 4) | spironolactone 25–200 mg/d (average dose 75 mg/d) |
|
Quinlan et al., 2020 [98] | retrospective study (n = 26, all female) (evidence level: 4) | spironolactone 50–100 mg/d ± metformin |
|
Metformin | |||
Verdolini et al., 2013 [101] | prospective study (n = 25) (evidence level: 4) | metformin 1000–1700 mg/d over 24 weeks |
|
Jennings et al., 2020 [99] | retrospective chart review (n = 53) (evidence level: 4) | metformin; mean dose 1.5 g/d; mean treatment duration 11.3 months |
|
Moussa et al., 2020 [100] | retrospective study (n = 16, pediatric HS patients) (evidence level: 4) | metformin as adjunctive treatment (dose not specified) |
|
Retinoids
References | Study Design (Level of Evidence, Oxford Criteria [84]) | Treatment Regimen | Efficacy Data/Results |
---|---|---|---|
Acitretin | |||
Boer et al., 2011 [104] | retrospective study (n = 12) (evidence level: 4) | acitretin monotherapy; mean dose 0.59 mg/Kg/d; duration 9–12 months (mean 10.8 months) |
|
Matusiak et al., 2014 [103] | prospective study (n = 17) (evidence level: 4) | acitretin; mean dose 0.56 ± 0.08 mg/Kg/d; treatment duration 9 months |
|
Tan et al., 2016 [111] | retrospective study (n = 14) (evidence level: 4) | acitretin as monotherapy (43%) or adjunctive to other systemic treatments (57%) (dose not specified) |
|
Sánchez-Díaz et al., 2022 [105] | retrospective cohort study (n = 62) (evidence level: 4) | acitretin (dose not specified) |
|
Isotretinoin | |||
Boer et al., 1999 [106] | retrospective study (n = 68) (evidence level: 4) | low-dose isotretinoin; mean dose 0.56 mg/Kg/d; for 4–6 months |
|
Soria et al., 2009 [108] | survey-based retrospective study (n = 87) (evidence level: 4) | isotretinoin (dose and treatment duration not specified) |
|
Patel et al., 2019 [107] | survey-based retrospective study (n = 39) (evidence level: 4) | isotretinoin (dose and treatment duration not specified) |
|
Adalimumab and Other TNFα Inhibitors
References | Study Design (Level of Evidence, Oxford Criteria [84]) | Treatment Regimen | Efficacy Data/Results |
---|---|---|---|
Kimball et al., 2012 [28] | phase II randomized placebo-controlled study (n = 154) (evidence level: 1b) |
|
|
Kimball et al., 2016 [113] | phase III randomized placebo-controlled study (PIONEER I) (n = 307) (evidence level: 1b) |
|
|
Kimball et al., 2016 [113] | phase III randomized placebo-controlled study (PIONEER II) (n = 326) (evidence level: 1b) |
|
|
Zouboulis et al., 2019 [114] | phase III open-label extension study of PIONEER I/II (n = 88) (evidence level: 2b) | ADA 40 mg every week |
|
Marzano et al., 2021 [116] | retrospective cohort study (n = 389) (evidence level: 2b) | ADA 40 mg every week from week 4, after initial doses of 160 mg at week 0 and 80 mg at week 2 |
|
Bechara et al., 2021 [117] | phase IV randomized placebo-controlled study (n = 206) (evidence level: 1b) | HS patients undergoing wide-excision surgery
|
|
3.3. What’s Coming Next? Promising Molecular Targets for Future HS Treatment
3.3.1. Interleukin-17
3.3.2. Interleukin-1
3.3.3. JAK/STAT Inhibitors
References | Study Design(Level of Evidence, Oxford Criteria [84]) | Treatment Regimen | Efficacy Data/Results |
---|---|---|---|
IL-17 (Secukinumab) | |||
Prussick et al., 2019 [151] | open-label pilot study (n = 9) evidence level: 4) | secukinumab 300 mg weekly for 5 weeks (loading dose) followed by 300 mg every 4 weeks for 24 weeks |
|
Casseres et al., 2020 [152] | open-label study (n = 20) (evidence level: 4) | secukinumab 300 mg weekly for 5 weeks (loading dose) followed by 300 mg every 2 or 4 weeks |
|
Reguiaï et al., 2020 [183] | retrospective study (n = 20) (evidence level: 4) | secukinumab 300 mg weekly for 5 weeks (loading dose) followed by 300 mg every 4 weeks |
|
Ribero et al., 2021 [184] | retrospective multicenter study (n = 31) (evidence level: 4) | secukinumab 300 mg weekly for 5 weeks (loading dose) followed by 300 mg every 4 weeks |
|
Kimball et al., 2022 [153] | 2 phase III randomized placebo-controlled trials (n = 1084)
|
|
|
IL-17 (Bimekizumab) | |||
Glatt et al., 2021 [34] | phase II randomized placebo- and active-comparator-controlled trial (n = 90) (evidence level: 1b) |
|
|
IL-1 (Anakinra) | |||
Leslie et al., 2014 [163] | open-label study (n = 6) (evidence level: 4) | anakinra 100 mg daily for 8 weeks |
|
Tzanetakou et al., 2016 [162] | phase II randomized placebo-controlled trial (n = 20) (evidence level: 2b) |
|
|
IL-1⍺(MABp1/Bermekimab) | |||
Kanni et al., 2018 [168] | phase II randomized placebo-controlled trial (n = 20); patients not eligible for anti-TNF⍺ treatment (evidence level: 2b) |
|
|
Kanni et al., 2021 [169] | open-label extension study of NCT02643654 (n = 8 *1) (evidence level: 4) | MABp1 (bermekimab) 7.5 mg/Kg every 2 weeks for 12 weeks | patients initially randomized to placebo achieved HiSCR in 75% after 12 weeks of MABp1 treatment |
Gottlieb et al., 2020 [170] | phase II open-label study (n = 42) (evidence level: 3b) | bermekimab 400 mg every week for 12 weeks in
|
|
JAK/STAT Inhibitors | |||
Alavi et al., 2022 [180] | open-label study (NCT03569371) (n = 10) (evidence level: 4) | INCB054707 15 mg p.o. daily for 8 weeks |
|
Alavi et al., 2022 [180] | phase II randomized placebo-controlled trial (NCT03607487) (n = 35) (evidence level: 2b) |
|
|
Kozera et al., 2022 [181] | retrospective cohort study (n = 20) (evidence level: 4) | upadacitinib for 12 weeks
|
|
3.4. Surgical Treatment Options
3.4.1. Incision and Drainage
3.4.2. Deroofing
3.4.3. Excision
3.4.4. Laser-Based Therapies
3.4.5. Postoperative Wound Management and Wound Closure Options
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Ocker, L.; Abu Rached, N.; Seifert, C.; Scheel, C.; Bechara, F.G. Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review. J. Clin. Med. 2022, 11, 7240. https://doi.org/10.3390/jcm11237240
Ocker L, Abu Rached N, Seifert C, Scheel C, Bechara FG. Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review. Journal of Clinical Medicine. 2022; 11(23):7240. https://doi.org/10.3390/jcm11237240
Chicago/Turabian StyleOcker, Lennart, Nessr Abu Rached, Caroline Seifert, Christina Scheel, and Falk G. Bechara. 2022. "Current Medical and Surgical Treatment of Hidradenitis Suppurativa—A Comprehensive Review" Journal of Clinical Medicine 11, no. 23: 7240. https://doi.org/10.3390/jcm11237240