Successful Treatment of Hidradenitis Suppurativa with Infliximab in a Patient Who Failed to Respond to Etanercept

Background. Hidradenitis suppurativa (HS) is a devastating chronic scarring disease of the axillae, groins, and submammary tissue occurring predominantly in women, with onset at puberty. Multiple treatments have been attempted, with limited success. The association of HS with Crohn disease, psoriasis (PSO), and pyoderma gangrenosum, as well as the seronegative arthropathies, uggests a common immunopathogenesis and has motivated attempts at treatment with anti-tumor necrosis factor (TNF)-alpha agents, already demonstrated to be efficacious in major inflammatory diseases. Objective To report on the clinical evolution of a patient with HS and PSO treated with infliximab who had failed to respond to etanercept and to discuss the possible mechanism responsible for the outcome. Methods: We describe the medical history, diagnostic tests, and clinical evolution of a 25-year-old woman with HS and psoriasis treated with infliximab. Results: The patient demonstrated a rapid and complete response with infliximab for the HS and PSO, sustained for 24 months. Conclusion: The success of anti-TNF agents such as infliximab in managing HS offers a new therapeutic option and supports an underlying immunologic basis for the disease. The differential response to HS observed with infliximab and etanercept in this patient could be related to differences in structure, binding specificities, or gene suppression.