Successful adalimumab therapy in hidradenitis suppurativa and acne conglobata

Abstract

Introduction Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent skin disorder in which diagnosis appears to be delayed for 7.2±8.7 years prolonging the burden of disease. Deep, painful nodules, tunnels (sinus tracts/fistulas), abscesses, double comedones, hypertrophic scars typically are present in groins, axilla, back, trunk, genital or perianal areas. HS is a component of the follicular occlusion tetrad along with acne conglobata (AC), dissecting cellulitis and pilonidal cyst. Aims and Objectives To report a case of HS with AC that was successfully treated with adalimumab. Materials and methods We present a case report of 31-year-old male with HS and AC who have received 1 year adalimumab therapy.Results Patient with a 1-year history of HS and 14 years history of AC presented to our clinic.Treatment with doxycycline 100 mg twice daily for 6 months and isotretinoin 60 mg daily for 6 months was without significant improvement. He had medical history of pilonidal sinus and was a smoker for 15 years. HS lesions were presented as fistulas and inflammatory nodules in axillary and inguinal regions (Hurley III stage, HS-PGA-5 points, IHS4-47 points, paint VAS-4 points and DLQI-21 points).On the back and trunk fistular comedones, hypertrophic scars and inflammatory nodules were presented. Patient was not obese, his body mass index was 23.31 kg/m2. Blood tests showed increased white blood cell (WBC) count (15.15 10*9/l) and Creactive protein (CRP) level (10.78 mg/L).Treatment with subcutaneous adalimumab 40 mg weekly was initiated and patient quit smoking.After 1 month of adalimumab injections, his pain decreased and purulent secretions ceased. His WBC count, CRP levels levels normalized and this response continued over the 12-month treatment period (IHS4-7 points, VAS-0, DLQI-8 point). Conclusions HS and AC can be recalcitrant to conventional therapies. This report provides further evidence to support the role of adalimumab in treatment-resistant cases.