New Approaches in Management and Treatment of Hidradenitis Suppurativa

  • Vesna Gajanin University of Banja Luka Faculty of Medicine
  • Nikola Baroš University of Banja Luka, Faculty of Medicine, Republic of Srpska, Bosnia and Herzegovina 2 University-Clinical Centre of the Republic of Srpska, Republic of Srpska, Bosnia and Herzegovina
  • Goran Marošević 1 University of Banja Luka, Faculty of Medicine, Republic of Srpska, Bosnia and Herzegovina Affidea, Radiotherapy Centre, Republic of Srpska, Bosnia and Herzegovina
  • Đuka Ninković Baroš University Clinical Center of Republic of Srpska, 1 University of Banja Luka, Faculty of Medicine, Republic of Srpska, Bosnia and Herzegovina
  • Jagoda Balaban University-Clinical Centre of the Republic of Srpska, Republic of Srpska, Bosnia and Herzegovina
Keywords: Hidradenitis suppurativa, Adalimumab, Radiotherapy, Skin autografting

Abstract


Background / Aim: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that most often affects apocrine gland-bearing areas of the skin. The treatment depends on the severity of the clinical presentation. The paper objective was to present new modalities in management and treatment of HS.
Methods: The subjects in this research included the patients suffering from the severe form of HS, who were treated in the University Clinical Centre of the Republic of Srpska for the past three years. The effect of treatment of HS were monitored. In four patients, biologic therapy with adalimumab or adalimumab biosimilars was administered, while four patients received radiotherapy and 17 of them, were treated surgically. Depending on the type of treatment, the effects of therapy were monitored after 6-12 weeks by using clinical examination and by assessing the disease stage according to the Hurley staging. Due to a small number of subjects, especially in patients treated with biologic and radiotherapy, it was not possible to perform any statistical analysis and the results were presented by description, in tables and photographs.
Results: Biologic therapy: Adalimumab was administered subcutaneously 80 mg, twice a month. After 12 weeks, in 4 patients was observed a regression of changes by 60-70 % when compared to previous skin changes. Radiotherapy: the total radiation dose was 5 Gy, distributed in 5 or 10 fractions. After 12 weeks an
improvement by 60-70 % was observed. Surgical treatment: after 6-8 weeks, the patients were fully recovered.
Conclusions: Application of biologic and radiotherapy after 12 weeks had similar results, ie it brought to regression of changes by 60-70 %. The best results were achieved after surgical treatment of HS.

References

Pavlović MD. Oboljenja apokrinih znojnih žlezda. U Karadaglić Đ. Dermatologija. Drugo izdanje. Beograd: Birograf Comp; 2016. p 815-22. Serbian.

Micheletti RG. Hidradenitis suppurativa: current views on epidemiology, pathogenesis, and pathophysiology. Semin Cutan Med Surg 2014;33(3 Suppl):S48-50.

Onderdijk AJ, van der Zee HH, Esmann S, Lophaven S, Dufour DN, Jemec GB, et al. Depression in patients with hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2013;27(4):473-8.

Hurley H. Axillary hyperhidrosis, apocrine bromhidrosis, hidradenitis suppurativa, and familial benign pemphigus: surgical approach. In: Roenigh R, Roenigh H, eds. Dermatologic surgery. New York: Marcel Dekker; 1989. p. 729–39.

Sartorius K, Emtestam L, Jemec GB, Lapins J. Objective scoring of hidradenitis suppurativa reflecting the role of tobacco smoking and obesity. Br J Dermatol 2009;161(4):831–9.

Kimball AB, Jamec GBE. Hidradenitis suppurativa: a disease primer. Switzerland: Springer International Publishing AG, 2017.

Boer J, Jemec GB. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol 2010;35(1):36–40.

Gener G, Canoui-Poitrine F, Revuz JE, Faye O, Poli F, Gabison G, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology 2009;219(2):148-54.

Soria A, Canoui Poitrine F, Wolkenstein P, Poli F, Gabison G, Pouget F, Viallette C, et al. Absence of efficacy of oral isotretinoin in hidradenitis suppurativa: a retrospective study based on patiens outcome assessment. Dermatology 2009;218(2):134–5.

Jemec GB. Clinical practice. Hidradenitis suppurativa. N Engl J Med 2012;366(2):158–64.

Agency for Medicines and Medical Devices of Bosnia and Herzegovina. [Internet]. [Cited: 1-Apr-2022].Available at: http://www.almbih.gov.ba/.

Mileusnić D, Marošević G, Durbaba M. Radijaciona onkologija. Banjaluka: Medicinski fakultet, 2020.

Ather S, Chan DSY, Leaper DJ, Harding KG. Surgical treatment of hidradenitis suppurativa: case series and review of the literature. Int Wound J 2006 Sep;3(3):159–69.

Harrison BJ, Mudge M, Hughes LE. Recurrence after surgical treatment of hidradenitis suppurativa. Br Med J (Clin Res Ed) 1987;294(6570):487-9.

Hessam S, Scholl L, Sand M, Schmitz L, Reitenbach S, Bechara FG. A novel severity assessment scoring system for hidradenitis suppurativa. JAMA Dermatol 2018;154(3):330–5.

Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord 2016;17(3):343–51.

Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: an update. J Am Acad Dermatol 2015;73(5 Suppl 1):S8–S11.

Canoui-Poitrine F, Le Thuaut A, Revuz JE, Viallette C, Gabison G, Poli F, et al. Identification of three hidradenitis suppurativa phenotypes: Latent class analysis of a cross-sectional study. J Invest Dermatol 2013;133(6):1506-11.

Martorell A, Jfri A, Koster SBL, Gomez-Palencia P, Solera M, Alfaro-Rubio A, et al. Defining hidradenitis suppurativa phenotypes based on the elementary lesion pattern: Results of a prospective study. J Eur Acad Dermatol Venereol 2020;34(6):1309–18.

Brajić I, Puizina Ivić N, Bukvić Mokos Z, Bolanača Ž, Vikšić Polić M, Žic R et al. Guidelines for he diagnostics an treatment of Hydradenitis suppurativa. Liječ Vijes 2017;139:247–53.

Zouboulis CC. Adalimumab for the treatment of hidradenitis suppurativa/acne inversa. Expert Rerv Clin Immunol 2016; 12(10): 1015–26.

Deckers IE, van der Zee HH, Boer J, Prens EP. Correlation of early-onset hidradenitis suppurativa with stronger genetic susceptibility and more widespread involvement. J Am Acad Dermatol 2015;72(3):485–8.

Hunger RE, Laffitte E, Läuchli S, Mainetti C, Mühlstädt M, Schiller P, et al. Swiss practice recommendations for the management of hidradenitis suppurativa/acne inversa. Dermatology 2017;233:113–9.

Xu J, Yang E, Yu NZ, Long X. Radiation therapy in keloids treatment: history, strategy, effectiveness, and complication. Chin Med J 2017;130(14):1715-6.

Ali AM, Thariat J, Bensadoun RJ, Thyss A, Rostom Y, El-Haddad S, et al. The role of radiotherapy in the treatment of pterygium: a review of the literature including more than 6000 treated lesions. Cancer Radiother 2011;15(2):140–7.

Pollock BE, Link MJ, Stafford SL, Lanzino G, Garces YI, Foote RL. Volume-staged stereotactic radiosurgery for intracranial arteriovenous malformations: outcomes based on an 18-year experience. Neurosurgery 2017;80(4):543-50.

Hendricks AJ, Hsiao JL, Lowes MA, Shi VY. Comparison of International Management Guidelines for Hidradenitis Suppurativa. Dermatology 2021;237(1):81–96.

Published
2022/06/29
Section
Original article