Derm Topics

Medical, Surgical & Laser-Based Treatment Strategies for Patients With Hidradenitis Suppurativa

The latest buzz word in hidradenitis suppurativa treatment is combination. Without a single, consistently and widely effective therapy, it’s important to build your own regimen by combining treatments, says Dr. Steven Daveluy, associate professor of dermatology and residency program director at Wayne State University School of Medicine. Next Steps in Derm, in partnership with ODAC Dermatology, Aesthetic & Surgical Conference, interviewed Dr. Daveluy about the medical, surgical and laser-based therapies available for hidradenitis suppurativa. Learn when you should consider combining therapies and how to get your patients on board. Find out what to do if your patients hit a medical therapy plateau. Plus hear Dr. Daveluy’s words of encouragement for dermatology clinicians who treat this challenging condition. 


Further Reading

If you want to read more about hidradenitis suppurativa therapies, check out the following articles published in the Journal of Drugs in Dermatology:

Dapsone to Treat Moderate-to-Severe Hidradenitis Suppurativa: A Retrospective Case-Series


Background: Management of hidradenitis suppurativa (HS) is challenging since no single treatment provides consistently effective results, leaving patients with frequent relapses. Dapsone combines anti-microbial and anti-inflammatory properties that address aspects of HS pathogenesis. Few studies have evaluated the efficacy of oral dapsone on HS, especially in severe disease.
Objective: This study aims to evaluate the clinical outcomes of patients with moderate-to-severe HS treated with dapsone. 

Methods: This retrospective chart review evaluated HS patients treated with oral dapsone over the past 10 years at one center. Treatment outcomes were classified based on Hurley staging, physician exam, and symptom progression. Adverse effects and concomitant treatment with dapsone were reviewed.

Results: Nineteen (19) patients with moderate-to-severe (Hurley Stage II-III) HS treated with oral dapsone were identified. Within 1-3 months, on dosages of dapsone varying from 25-100 mg/day, 3 patients (15.8%) had a clinically significant improvement in symptoms, 10 patients (52.6%) had a slight improvement, and 6 patients (31.6%) had no change in disease state; no patients deteriorated. The majority who improved were also on other medications, most commonly adalimumab. 4 patients experienced adverse effects, with nausea being most common; otherwise, dapsone was well-tolerated.

Conclusions: Dapsone may have some efficacy for moderate-to-severe HS and seems well-tolerated.

Hormonal Treatments in Hidradenitis Suppurativa: A Systematic Review

Background: Hidradenitis suppurativa (HS) is an inflammatory skin condition characterized by recurrent abscesses, nodules, and sinus tracts. Hormones are thought to play an important role in HS pathophysiology, but there is a lack of an updated review on hormonal treatments in HS. 

Objective: Perform a systematic review of the literature on hormonal treatments in patients with HS. 

Methods: In April 2022, MEDLINE and EMBASE databases were searched for articles on hormonal treatments in HS. Non-English, duplicate, and irrelevant results were excluded. Data extraction was performed by two reviewers. 

Results: From 1952 to 2022, 30 articles (634 patients) met the inclusion criteria. Anti-androgen treatments discussed include finasteride (n=8), spironolactone (n=7), cyproterone acetate (CPA) (n=5), flutamide (n=1), leuprolide (n=1), and buserelin acetate (n=1). Metabolic treatments reported include metformin (n=8) and liraglutide (n=2). Three articles on hormonal contraceptives and 2 articles on testosterone were included. Of the articles which reported response rates, 62.8% (27/43) of patients improved with finasteride, 53.3% (32/60) with CPA mono/combination therapy, 50.5% (51/101) with spironolactone, and 46.0% (74/161) with metformin. Improvement in HS was also noted in case reports of patients treated with buserelin acetate, leuprolide, flutamide, and liraglutide.   

Conclusions: Hormonal treatments for HS, especially finasteride, spironolactone, and metformin, are efficacious and safe; but large-scale randomized controlled trials are needed to determine the patient populations which would benefit from these therapies.

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