Review 2004 © Ashley Publications Ltd ISSN 1465-6566 1767 Ashley Publications ww w.ashley-pub.com 1. Introduction 2. Goal of therapy 3. Current best practice 4. Other factors 5. Expert opinion Medical treatment of hidradenitis suppurativa Gregor BE Jemec Division of Dermatology, Dept of Medicine, Roskilde Hospital, DK-4000 Roskilde, Denmark Hidradenitis suppurativa (HS) is a common skin disease affecting an esti- mated 2% of the population. It causes significant symptoms and is notori- ously difficult to treat. In this article, the current medical therapy is reviewed. At the present time, therapy appears to be based on an interpretation of the disease as either infectious or a form of acne. The understanding of the pathogenesis of HS suggests that these are not adequate models in order to understand the disease and this may explain the insufficiency of currently available medical treatment. The literature is sparse and there is a shortage of randomised, controlled trials. Three small, randomised, controlled trials have suggested that clindamycin, tetracycline and oestrogens and cyprotero- neacetate may have an effect in some patients. Preceiving HS as an inflamma- tory skin disease suggests the use of general immunosuppressive drugs in the treatment of this condition. This approach, using both traditional immuno- supressants and monoclonal antibodies, has been assessed in a small number of patients and appears to have some potential. However, the main source of evidence for this are case series and there is a strong need for more formal studies in this potentially debilitating disease. Keywords: antiandrogens, clindamycin, hidradenitis suppurativa, immunosupressants, infliximab, quality of life, retinoids, skin disease, systemic therapy, tetracycline, topical therapy Expert Opin. Pharmacother. (2004) 5(8):1767-1770 1. Introduction Hidradenitis suppurativa (HS) is a common, disabling dermatosis with a profound impact to patients quality of life [1,2]. T he clinical presentation of the disease is char- acteristic and allows simple diagnosis. It has been suggested that HS be described as inverse recurrent suppuration (IRS) as this sums up its clinical presentation of recur- rent lesions clinically resembling boils, unresponsive to conventional therapy, located to inverse areas. T he lesions are not cystic as with boils, which explains the lack of effect of simple lancing, nor do the patients have lesions outside inverse areas. Clinically HS has three stages: • Primary stage: boils appear in separate places and where nodular non-inflamed precursor lesions appear as well. • Secondary stage: sinus tracts appear with scarring linking individual lesions. • Tertiary stage: coaleasing, scarring and sinus tracts predominate although inflam- mation and chronic discharge also appear. T he disease causes symptoms. Patients are frequently bothered by pain, scarring, recurrent discharge and smell from the lesions [2-4]. It is easy to imagine the impact of the disease on the lives of patients and it has been shown to have a high impact on their quality of life [2]. The aetiology of the disease remains unknown, but it is a disease of the hair folli- cles of the inverse areas of the body, predominantly the axillae and the genitofemoral areas. Bacteria are present in a minority of lesions and known pathogens such as Sta- phylococcus aureus occur only in a minority of lesions. The disease is therefore related For reprint orders, please contact: reprints@ashley-pub.com