Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa

Abstract

Hidradenitis suppurativa/acne inversa (HS) is a chronic inflammatory skin disease characterized by painful, recurrent nodules and abscesses that rupture and lead to sinus tracts and scarring. To date, an evidence-based therapeutic approach has not been the standard of care and this is likely due to the lack of evidence based treatment guidelines. The purpose of this study was to promote a holistic evidence-based approach which implemented Level of Evidence and Strength of Recommendation for the treatment of HS. Based upon the European Dermatology Forumguidelines for the management of HS, evidence-based approach was explored for the treatment of HS. The diagnosis of HS should be made by a dermatologist or other healthcare professional with expert knowledge in HS. All patients should be offered adjuvant therapy as needed (pain management, weight loss, tobacco cessation, treatment of super infections, and application of appropriate dressings). The treating physician should be familiar with disease severity scores, especially Hurley staging, physician global assessment and others. The routine use of patient’reported outcomesincluding DLQI, itch and pain assessment (Visual Analogue Scale) is strongly recommended. The need for surgical intervention should be assessed in all patients depending upon type and extent of scarring, and an evidence-based surgical approach should be implemented. Evidence-based medical treatment of mild disease consists of topical Clindamycin 1 % solution/gel b.i.d. for 12 weeks or Tetracycline 500 p.o. b.i.d. for 4 months (LOE IIb, SOR B), for more widespread disease. If patient fails to exhibit response to treatment or for a PGA of moderate-to-severe disease, Clindamycin 300 p.o. b.i.d. with Rifampicin 600 p.o. o.d. for 10 weeks (LOE III, SOR C) should be considered. If patient is not improved, then Adalimumab 160 mg at week 0, 80 mg at week 2; then 40 mg subcutaneously weekly should be administered (LOE Ib, SOR A). If improvement occurs then therapy should be maintained as long as HS lesions are present. If the patient fails to exhibit response, then consideration of second or third line therapy is required. A growing body of evidence is being published to guide the treatment of HS. HS therapy should be based upon the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines. Treatment should include surgery as well as medical treatment. Future studies should include benefit risk ratio analysis and long term assessment of efficacy and safety, in order to facilitate long term evidence based treatment and rational pharmacotherapy.

Pirminės Sveikatos Priežiūros Specialistų Žinios Apie Supūliavusį Hidradenitą

“…Hidradenitis suppurativa, SH) -lėtinė, uždegiminė odos liga, pasireiškianti atsinaujinančiais skausmingais mazgais ir abscesais, besiformuojančiais sinusais, takais tarp jų, randais [1]. Dažniausiai SH prasideda pasibaigus brendimo laikotarpiui, apima plauko folikulus ir pasireiškia skausmingais, giliai odoje esančiais, uždegiminias dariniais, anatominėse apokrininių liaukų kūno vietose, dažniausiai pažastyse, kirkšnyse ar anogenitalinėse srityse [2].…”

“…III stadija Difuzinis paplitimas tarp keleto tarpusavyje susijusių sinusų ir pūlinių. [1]. Apie SH priežastis, vystymosi eigą, gydymą iki šiol mažai žinoma, todėl ši liga išlieka mįslė įvairių specialybių gydytojams.…”

Hidradenitis suppurativa: why isn’t it a form of acne?

“…Mindezek alapján a lokális clindamycin naponta kétszer alkalmazva lokalizált Hurley I. és enyhe Hurley II. stádiumú betegség esetén elsővonalbeli kezelésként javasolható (28,31). Az irodalomban hasonló stádiumban 15%-os resorcin tartalmú krém és intralézionális triamcinolon acetonid alkalmazásá-ról olvashatunk egy-egy gyulladt, fájdalmas lézió esetén (32).…”

“…Hurley I. és enyhe Hurley II. stadiumú, kiterjedt betegségben napi 2x500 mg dózisban 3-4 hónapig alkalmazhatóak (28,31). A clindamycin (2x300 mg) és rifampicin (1x600, 2x300 mg) antibiotikumok kombinációja egyike a leghatékonyabb kezeléseknek HS-ben gyulladásos tünetek esetén.…”

Hidradenitis Suppurativa: Modern Concepts of Pathogenesis and Therapy; Successful Experience of Adalimumab Therapy

“…При неэффек-тивности препаратов первых 2 линий назначаются пре-параты 3-й линии: колхицин, ботулотоксин, изотретиноин, дапсон и циклоспорин; а также терапия, корригирующая гормональный статус (антиандрогены). Адъювантная те-рапия и мероприятия при ГС предполагают купирование болевого синдрома, лечение вторичной инфекции, а так-же коррекцию веса и отказ от курения [33] (см. рис.…”