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Martora F, Megna M, Battista T, Potestio L, Annunziata MC, Marasca C, Villani A, Fabbrocini G. Adalimumab, Ustekinumab, and Secukinumab in the Management of Hidradenitis Suppurativa: A Review of the Real-Life Experience. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2023; 16:135-148. [PMID: 36698446 PMCID: PMC9869696 DOI: 10.2147/ccid.s391356] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2023]
Abstract
To date, adalimumab (ADA) is the only biotechnology drug approved for the management of hidradenitis suppurativa (HS), an inflammatory skin condition. However, it quickly became apparent that the efficacy of adalimumab in daily practice was highly variable. In our review, we highlighted the current evidence from literature on the use of biologics in HS in a real-life setting, particularly adalimumab, secukinumab and ustekinumab. Data on the effectiveness and safety of biologic drugs in HS management have been analyzed. Even if the results are promising, more studies are needed. In our opinion, the armamentarium of drugs for HS management is increasing, and treatment will be based on a tailored-tail approach, minimizing the risk of adverse events. In this context, we want to point out the reported effectiveness and safety data concerning adalimumab, ustekinumab and secukinumab as well as ixekizumab.
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Affiliation(s)
- Fabrizio Martora
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy,Correspondence: Fabrizio Martora, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39 - 081 – 7462457, Fax +39 - 081 – 7462442, Email
| | - Matteo Megna
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Teresa Battista
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Luca Potestio
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Maria Carmela Annunziata
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Claudio Marasca
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Alessia Villani
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
| | - Gabriella Fabbrocini
- Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy
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Yidana DB. Hidradenitis suppurativa - The role of interleukin-17, the aryl hydrocarbon receptor and the link to a possible fungal aetiology. Med Hypotheses 2021; 149:110530. [PMID: 33607406 DOI: 10.1016/j.mehy.2021.110530] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/14/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022]
Abstract
Hidradenitis Suppurativa (HS) is a chronic, recurrent, debilitating skin disease of the hair follicle that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland bearing areas of the body, most commonly the axillae, inguinal and anogenital regions. The pathophysiology of the disease remains elusive, with newer therapies targeting various aspects of the dysregulated immune system. This presents a useful opportunity to look at the cytokine profile in HS and other inflammatory conditions that share similar patterns with the aim of teasing out less considered explanations for HS pathogenesis. It has been observed that IL-17 appears to be the most common denominator linking HS with other immune mediated diseases like Crohn, ulcerative colitis, multiple sclerosis and psoriasis. Given that IL-17 plays an important role in antifungal immunity, evidenced by the cytokine pattern in fungal disease and the bulk of data citing their potential involvement in Crohn, ulcerative colitis, multiple sclerosis and psoriasis; it is fair to suggest the need to explore the role that fungi play in the setting of HS going forward. The aryl hydrocarbon receptor (ahr) is a ubiquitous and largely conserved entity that is gaining interest in inflammatory conditions such as psoriasis and atopic dermatitis. It is well known to modulate autoimmune states. Its activation by both exogenous and endogenous agents result in secretion of IL-17 by Th17 cells. One of such agents is the tryptophan metabolite 6-formylindolo [3,2-b] carbazole (FICZ)-which can be produced by microorganisms such as fungi. It will be interesting to explore its usefulness in HS pathogenesis.
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Affiliation(s)
- Daniel B Yidana
- King's College London, St. John's Institute of Dermatology, Strand, London WC2R 2LS, United Kingdom.
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Włodarek K, Ponikowska M, Matusiak Ł, Szepietowski JC. Biologics for hidradenitis suppurativa: an update. Immunotherapy 2019; 11:45-59. [PMID: 30702012 DOI: 10.2217/imt-2018-0090] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory dermatosis characterized by an occurrence of nodules, abscesses, sinus tracks and scarring. Its pathogenesis is multifactorial and still not fully understood, therefore, current systemic therapies still remain a serious challenge. Increased levels of several proinflammatory cytokines have been reported in patients suffering from HS, therefore biologics appear as a new approach to therapy for this condition. Adalimumab is the only one internationally registered agent and should be considered first after the conventional therapies appear insufficient. The efficacy and safety profile of some preparations, like infliximab and etanercept was confirmed so far in randomized trials, but there are some new biologics which are still being evaluated and require more rigorous examination.
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Affiliation(s)
- Katarzyna Włodarek
- Department of Dermatology, Venereology & Allergology, Medical University, Wroclaw, Poland
| | - Małgorzata Ponikowska
- Department of Dermatology, Venereology & Allergology, Medical University, Wroclaw, Poland
| | - Łukasz Matusiak
- Department of Dermatology, Venereology & Allergology, Medical University, Wroclaw, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology & Allergology, Medical University, Wroclaw, Poland
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Alikhan A, Sayed C, Alavi A, Alhusayen R, Brassard A, Burkhart C, Crowell K, Eisen DB, Gottlieb AB, Hamzavi I, Hazen PG, Jaleel T, Kimball AB, Kirby J, Lowes MA, Micheletti R, Miller A, Naik HB, Orgill D, Poulin Y. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol 2019; 81:91-101. [PMID: 30872149 PMCID: PMC9131892 DOI: 10.1016/j.jaad.2019.02.068] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/21/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Hidradenitis suppurativa is a severe and debilitating dermatologic disease. Clinical management is challenging and consists of both medical and surgical approaches, which must often be combined for best outcomes. Therapeutic approaches have evolved rapidly in the last decade and include the use of topical therapies, systemic antibiotics, hormonal therapies, and a wide range of immunomodulating medications. An evidence-based guideline is presented to support health care practitioners as they select optimal medical management strategies and is reviewed in this second part of the management guidelines. A therapeutic algorithm informed by the evidence available at the time of the review is provided.
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Affiliation(s)
| | - Christopher Sayed
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Afsaneh Alavi
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Raed Alhusayen
- Department of Medicine, Division of Dermatology, University of Toronto, Toronto, Ontario, Canada
| | - Alain Brassard
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Craig Burkhart
- Department of Dermatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karen Crowell
- Health Sciences Library, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Daniel B Eisen
- Department of Dermatology, University of California at Davis, Sacramento, California
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai Hospital, New York, New York
| | - Iltefat Hamzavi
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | | | - Tara Jaleel
- Department of Dermatology, Duke University School of Medicine, Durham, North Carolina
| | - Alexa B Kimball
- Department of Dermatology, Harvard Medical School, Boston, Massachusetts
| | - Joslyn Kirby
- Department of Dermatology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | | | - Robert Micheletti
- Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Angela Miller
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan
| | - Haley B Naik
- Department of Dermatology, University of California San Francisco, San Francisco, California
| | - Dennis Orgill
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Yves Poulin
- Centre de Recherche Dermatologique du Quebec Metropolitain, Quebec City, Quebec, Canada
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Roy CF, Roy SF, Ghazawi FM, Patocskai E, Bélisle A, Dépeault A. Cutaneous squamous cell carcinoma arising in hidradenitis suppurativa: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19847359. [PMID: 31205707 PMCID: PMC6537059 DOI: 10.1177/2050313x19847359] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We present a case of a 64-year-old man who presented with a rapidly growing tumor
in the left buttock and intergluteal cleft area, which was affected by
hidradenitis suppurativa. The patient was on tumor necrosis factor-alpha
inhibitors for hidradenitis suppurativa for 2 years prior to the development of
the mass. Initial biopsy of the mass showed a well-differentiated squamous cell
carcinoma with spindle cells and positive epithelial immunomarkers. Subsequent
excisional biopsy of the tumor showed an infiltrating poorly differentiated
squamous cell carcinoma composed of islands of atypical sarcomatoid spindle
cells. Squamous cell carcinoma arising in hidradenitis suppurativa is a rare
complication which may occur secondary to chronic inflammation and epidermal
hyperproliferation in hidradenitis suppurativa–affected areas.
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Affiliation(s)
- Catherine F Roy
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Simon F Roy
- Division of Pathology, University of Montreal, Montreal, QC, Canada
| | - Feras M Ghazawi
- Division of Dermatology, University of Ottawa, Ottawa, ON, Canada
| | - Erica Patocskai
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Annie Bélisle
- Division of Pathology, University of Montreal, Montreal, QC, Canada
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Lim SYD, Oon HH. Systematic review of immunomodulatory therapies for hidradenitis suppurativa. Biologics 2019; 13:53-78. [PMID: 31190730 PMCID: PMC6526329 DOI: 10.2147/btt.s199862] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Accepted: 03/22/2019] [Indexed: 12/21/2022]
Abstract
Background: Greater understanding of the roles of tumor necrosis factor-α, IL-1β, IL-10, and the IL-23/T-helper (Th) 17 and IL-12/Th1 pathways in immune dysregulation in moderate/severe hidradenitis suppurativa (HS) has helped in developing new regimens. We aim to review the use of different immunomodulatory therapies used to manage HS. Methods: A comprehensive literature search was conducted on the PubMed and Clinicaltrials.gov databases from 1 January 1947 to 31 December 2018. Only clinical trials, case reports, case series and retrospective analyses published in the English language were included. Results: Our search yielded 107 articles and 35 clinical trials, of which 15 are still ongoing. The tumor necrosis factor-α inhibitors adalimumab and infliximab were the most comprehensively studied agents. Published data from clinical trials support the efficacy of adalimumab, infliximab, anakinra, ustekinumab, bermekimab and apremilast but not etanercept and MEDI8968. Clinical trials for CJM112 have been completed, with results awaiting publication. Trials are underway for secukinumab, IFX-1, INCB054707 and bimekizumab. Biologics used in smaller cohorts include canakinumab, golimumab and rituximab. Most agents are well tolerated and demonstrate a good safety profile, with the most commonly reported adverse event being infections. Discussion and conclusions: To date, adalimumab is the only biologic which has been approved by the United States Food and Drug Administration for HS. However, other agents also show promise, with further trials underway to evaluate their efficacy, tolerability and safety profiles. Different clinical measurement scores and endpoints used to make direct comparison difficult. Longitudinal surveillance and pooled registry data are paramount to evaluate the long-term safety profile and efficacy of therapy.
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Affiliation(s)
- Shi Yu Derek Lim
- Internal Medicine Residency, National Healthcare Group, Singapore, Singapore
| | - Hazel H Oon
- Department of Dermatology, National Skin Centre, Singapore, Singapore
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Moran B, Sweeney CM, Hughes R, Malara A, Kirthi S, Tobin AM, Kirby B, Fletcher JM. Hidradenitis Suppurativa Is Characterized by Dysregulation of the Th17:Treg Cell Axis, Which Is Corrected by Anti-TNF Therapy. J Invest Dermatol 2017; 137:2389-2395. [PMID: 28652108 DOI: 10.1016/j.jid.2017.05.033] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 01/05/2023]
Abstract
Hidradenitis suppurativa (HS) is a chronic, inflammatory, and debilitating disease of hair follicles with 1-4% prevalence and high morbidity. There is a dearth of information on the pathogenesis and immune dysregulation underlying HS; therefore, we carried out a detailed analysis of skin-infiltrating T cells. Cells isolated from skin biopsy samples and blood from HS patients and healthy control subjects were analyzed by 16-parameter flow cytometry to provide detailed profiles of CD4 T-cell subsets. We observed substantial infiltration of inflammatory T cells with a striking T helper (Th) type 17-skewed cytokine profile in HS skin; these cells expressed the Th17 lineage marker CD161 and IL-17, as well as proinflammatory cytokines GM-CSF, IL-22, IFN-γ, and tumor necrosis factor. Regulatory T cells were also enriched in HS lesional skin; however, the ratio of Th17 to regulatory T cells was nonetheless highly dysregulated in favor of Th17 cells. In contrast, lesional skin from anti-tumor necrosis factor-treated HS patients who showed substantial clinical improvement exhibited a significant reduction in the frequency of Th17 cells and normalization of the Th17 to regulatory T cell ratio. These data suggest that inhibition of pathogenic IL-17 via tumor necrosis factor blockade is associated with improvement in immune dysregulation in HS and may provide a rationale for targeting IL-17 in the disease.
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Affiliation(s)
- Barry Moran
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland
| | - Cheryl M Sweeney
- Dermatology Research, Education and Research Centre, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Rosalind Hughes
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Anna Malara
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | | | - Anne-Marie Tobin
- Department of Dermatology, Tallaght Hospital, Dublin 24, Ireland
| | - Brian Kirby
- Department of Dermatology, St. Vincent's University Hospital, Dublin 4, Ireland
| | - Jean M Fletcher
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland; School of Medicine, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.
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Zouboulis CC. Adalimumab for the treatment of hidradenitis suppurativa/acne inversa. Expert Rev Clin Immunol 2016; 12:1015-26. [DOI: 10.1080/1744666x.2016.1221762] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Verdelli A, Antiga E, Bonciani D, Bonciolini V, Volpi W, Caproni M. A fatal case of hidradenitis suppurativa associated with sepsis and squamous cell carcinoma. Int J Dermatol 2015; 55:e52-3. [DOI: 10.1111/ijd.13006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/19/2015] [Accepted: 02/12/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Alice Verdelli
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Emiliano Antiga
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Diletta Bonciani
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Veronica Bonciolini
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Walter Volpi
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Marzia Caproni
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
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Hidradenitis Suppurativa: A Frequently Missed Diagnosis, Part 2: Treatment Options. Adv Skin Wound Care 2015; 28:372-80; quiz 381-2. [PMID: 26181861 DOI: 10.1097/01.asw.0000466712.21948.8a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the intertriginous area. Patients with HS have several challenges to their quality of life and activities of everyday living, including malodor, purulent discharge, and discomfort. There is often a delay in diagnosis and appropriate treatment. The need for cosmetically acceptable local treatments and dressing application makes this disease an important challenge for wound care specialists. The choice of optimal treatment varies depending on the disease severity, expert knowledge, the availability of an interprofessional team, and patient factors.
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