Adalimumab in treatment-resistant hidradenitis suppurativa following recurrence after extensive affected area excision: A review of biologies therapy

Background: Hidradenitis suppurativa (HS) is characterized by chronic, suppurative abscesses, sinus tracts, and fistulas affecting the axilla, groin, and perianal region resulting from hyperkeratosis and occlusion of the terminal hair follicle. Objective: This report highlights the use of biologic agents for the treatment of recalcitrant HS. Method: We report on a 48-year-old male with a 15-year history of refractory perianal-inguinal-buttock HS who, despite receiving numerous surgical drainages and traditional medical treatmentfor HS, still had severe pain. After trialing etanercept and infliximab with methotrexate, the patient had marked improvement with adalimumab. Aliterature review of biologies therapywas also performed. Results: After trialing m any traditional therapies, we found that adalimumab appears to be the mosteffective treatment modalityfor our patient. A literature search revealed 53 articles on biologies therapy in HS. These articles are summarized. Discussion: Biologic agents have been shown to have variable results in the treatment of refractory HS. Enough lowgrade evidence has been accumulated to make the use of these agents suitable in HS. Until more clinical trials are performed on this topic, physicians should use clinical judgment when treating HS with biologic agents and be cautious by watching for significant adverse effects.