Effective long-term control of refractory hidradenitis suppurativa with adalimumab after failure of conventional therapy

Background Hidradenitis suppurativa is a chronic suppurative condition featuring inflammatory nodules, fistulas and scars. It occurs predominantly in the axillae and groin. The disease is poorly responsive to any treatment and is connected with significant morbidity. Systemic therapy, including oral antibiotics, retinoids and antiandrogens, usually has only limited effect. Surgical treatment of affected areas is necessary in advanced stages. Objectives Several reports support the beneficial effect of tumor necrosis factor-alpha (TNF-alpha) antagonists for the treatment of severe hidradenitis suppurativa. By contrast with data on infliximab and etanercept, data describing the potential positive influence of adalimumab on disease outcome are limited and refer to only small cohorts of patients. Methods Eight patients with severe, recalcitrant hidradenitis were treated for 1 year with adalimumab in a standard regimen and were subsequently followed for 1 year. Results All patients improved within 4-6 weeks and laboratory parameters of C-reactive protein (CRP) and leukocyte count reduced significantly during treatment. Three patients demonstrated long-lasting improvement and five showed recurrences several months after discontinuation of the therapy. The average recurrence-free interval was 9.5 months. Conclusions Adalimumab is suitable for the long-term treatment of hidradenitis suppurativa and presents a further conservative treatment approach.