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Indian J Dermatol Venereol Leprol. 2019 Mar 20. doi: 10.4103/ijdvl.IJDVL_69_18. [Epub ahead of print]

Hidradenitis suppurativa: A systematic review and meta-analysis of therapeutic interventions.

Author information

1
Unit of Wounds and Healing, Department of Trauma and Orthopaedic Surgery, Centre Hospitalier Louis Constant Fleming Saint Martin, Saint Martin, Guadeloupe, France.
2
Department of Trauma and Orthopaedic Surgery, Montpellier University Hospital, Montpellier, France.
3
Department of Plastic and Reconstructive Surgery, Wound Healing and Burns Units, Lapeyronie University Hospital, Montpellier, France.

Abstract

Hidradenitis suppurativa is a chronic inflammatory condition that affects skin regions bearing apocrine glands. Although hidradenitis suppurativa is difficult to treat and cure, the currently available treatments are directed toward managing the lesions and associated symptoms. This review presents an evidence-based outline of the available treatment options. We searched four electronic databases and extracted data from retrieved studies for qualitative or quantitative analysis. Meta-analysis was conducted using the comprehensive meta-analysis software to generate pooled standardized mean differences or risk ratios. Numerous medical treatments are available for hidradenitis suppurativa such as antibiotics, retinoids, antiandrogens, immunosuppressive and anti-inflammatory agents and radiotherapy for early lesions. Adalimumab, an anti-tumor necrosis factor antibody, was superior to placebo in reducing Sartorius score (standardized mean difference = -0.32, confidence interval [-0.46, -0.18], P < 0.0001) and pain (risk ratio = 1.42, confidence interval [1.07, 1.9], P = 0.02), when given weekly (not every other week). Combination therapies (such as antibiotics and hyperbaric oxygen therapy) have been tested, which have shown promising results that are yet to be confirmed. Based on the quality of evidence, the most recommended treatments for hidradenitis suppurativa include adalimumab and laser therapy. Surgery (either by simple excision or complete local excision followed by skin graft) is the first choice for intractable disease presenting in the late stages. However, the evidence on most of these treatments is deficient and further randomized trials are needed to establish the most efficient therapies for hidradenitis suppurativa management.

KEYWORDS:

Acne inversa; adalimumab; antibiotics; hidradenitis suppurativa; immunosuppressive therapy; laser; surgery

PMID:
30924446
DOI:
10.4103/ijdvl.IJDVL_69_18

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