Hidradenitis suppurativa (HS) is a refractory and recurrent chronic inflammatory skin disease characterized by nodules, abscesses, sinus tracts, and scarring. The etiology of HS remains unclear, rendering its treatment particularly challenging. Current therapeutic approaches encompass lifestyle modifications, topical medications, conventional systemic drugs, biologic agents, surgical interventions, and traditional Chinese medicine (TCM). A personalized treatment strategy tailored to individual patient characteristics is essential to achieve optimal clinical outcomes.
References
[1]
Belamarić, M., Miše, J. and Bukvić Mokos, Z. (2023) The Association Between Hidradenitis Suppurativa and Diet: An Update. Acta Dermatovenerologica Croatica, 31, 213-219.
[2]
Pandey, A. (2024) Essentials of Hidradenitis Suppurativa: A Comprehensive Review of Diagnostic and Treatment Perspectives. Annals of Medicine & Surgery, 86, 5304-5313. https://doi.org/10.1097/ms9.0000000000002345
[3]
Wang, B., Yang, W., Wen, W., Sun, J., Su, B., Liu, B., et al. (2010) Γ-Secretase Gene Mutations in Familial Acne Inversa. Science, 330, 1065-1065. https://doi.org/10.1126/science.1196284
[4]
He, Y., Xu, H., Li, C., Zhang, X., Zhou, P., Xiao, X., et al. (2019) Nicastrin/miR-30a-3p/RAB31 Axis Regulates Keratinocyte Differentiation by Impairing EGFR Signaling in Familial Acne Inversa. Journal of Investigative Dermatology, 139, 124-134. https://doi.org/10.1016/j.jid.2018.07.020
[5]
Kelly, G., Hughes, R., McGarry, T., Born, M., Adamzik, K., Fitzgerald, R., et al. (2015) Dysregulated Cytokine Expression in Lesional and Nonlesional Skin in Hidradenitis Suppurativa. British Journal of Dermatology, 173, 1431-1439. https://doi.org/10.1111/bjd.14075
[6]
Xu, H., He, Y., Hui, Y., Xiao, X., Zhang, X., Li, C., et al. (2016) NCSTN Mutations in Hidradenitis Suppurativa/Acne Inversa Do Not Influence Cytokine Production by Peripheral Blood Mononuclear Cells. British Journal of Dermatology, 176, 277-279. https://doi.org/10.1111/bjd.15076
[7]
Nazary, M., van der Zee, H.H., Prens, E.P., Folkerts, G. and Boer, J. (2011) Pathogenesis and Pharmacotherapy of Hidradenitis Suppurativa. European Journal of Pharmacology, 672, 1-8. https://doi.org/10.1016/j.ejphar.2011.08.047
[8]
Zouboulis, C.C., Benhadou, F., Byrd, A.S., Chandran, N.S., Giamarellos‐Bourboulis, E.J., Fabbrocini, G., et al. (2020) What Causes Hidradenitis Suppurativa?—15 Years After. Experimental Dermatology, 29, 1154-1170. https://doi.org/10.1111/exd.14214
[9]
Napolitano, M., Calzavara‐Pinton, P.G., Zanca, A., Bianchi, L., Caposiena Caro, R.D., Offidani, A.M., et al. (2018) Comparison of Clinical and Ultrasound Scores in Patients with Hidradenitis Suppurativa: Results from an Italian Ultrasound Working Group. Journal of the European Academy of Dermatology and Venereology, 33, e84-e87. https://doi.org/10.1111/jdv.15235
[10]
Hutcherson, J.A., Scott, D.A. and Bagaitkar, J. (2015) Scratching the Surface-Tobacco-Induced Bacterial Biofilms. Tobacco Induced Diseases, 13, 1. https://doi.org/10.1186/s12971-014-0026-3
[11]
Vural, S., Baskurt, D., Yıldırıcı, Ş., Rasulova, G., Danacı, S. and Botsalı, A. (2024) Evaluating Dietary Considerations in Hidradenitis Suppurativa: A Critical Examination of Existing Knowledge. International Journal of Dermatology, 63, 987-998. https://doi.org/10.1111/ijd.17101
[12]
Lackner, L., Zyriax, B. and Stephan, B. (2024) To What Extent Does Vitamin D and Its Serum Levels Influence the Severity of Hidradenitis Suppurativa: A Literature Review. Acta Dermato-Venereologica, 104, adv40321. https://doi.org/10.2340/actadv.v104.40321
[13]
Consensus Writing Group on the Diagnosis and Treatment of Acne Inversa/Hidradenitis Suppurativa in China (2021) Diagnosis and Treatment of Acne Inversa/Hidradenitis Suppurativa in China: An Expert Consensus Statement (2021 Version). Chinese Journal of Dermatology, 54, 97-104.
[14]
Kirchner, S., Yesil, H. and Jaleel, T. (2025) Hidradenitis Suppurativa Management with Antibiotics and Systemic Therapies. Dermatologic Clinics, 43, 221-229. https://doi.org/10.1016/j.det.2024.12.007
[15]
Jemec, G.B.E. and Wendelboe, P. (1998) Topical Clindamycin versus Systemic Tetracycline in the Treatment of Hidradenitis Suppurativa. Journal of the American Academy of Dermatology, 39, 971-974. https://doi.org/10.1016/s0190-9622(98)70272-5
[16]
Liao, Y., Chu, C., Hui, C.R., Li, C., Lin, S., Tseng, H., et al. (2024) Journal of the Formosan Medical Association, 123, 1228-1238. https://doi.org/10.1016/j.jfma.2023.12.012
[17]
Wiala, A., Daschl, S.M., Stockinger, T., Rappersberger, K. and Posch, C. (2024) Oral Fusidic Acid for the Treatment of Mild‐to‐Moderate Hidradenitis Suppurativa. International Journal of Dermatology, 63, 1205-1211. https://doi.org/10.1111/ijd.17115
[18]
Araujo, F.G., Slifer, T.L. and Remington, J.S. (2002) Effect of Moxifloxacin on Secretion of Cytokines by Human Monocytes Stimulated with Lipopolysaccharide. Clinical Microbiology and Infection, 8, 26-30. https://doi.org/10.1046/j.1469-0691.2002.00374.x
[19]
Vu, D., Park, M. and Alhusayen, R. (2024) Efficacy of Moxifloxacin as a Mono-Antibiotic Therapy for Hidradenitis Suppurativa: A Retrospective Cohort Study. Journal of the American Academy of Dermatology, 91, 583-585. https://doi.org/10.1016/j.jaad.2024.05.065
[20]
Rozin, A., Schapira, D., Braun-Moscovici, Y. and Nahir, A.M. (2001) Cotrimoxazole Treatment for Rheumatoid Arthritis. Seminars in Arthritis and Rheumatism, 31, 133-141. https://doi.org/10.1053/sarh.2001.27734
[21]
Park, M., Vu, D. and Alhusayen, R. (2024) Trimethoprim-Sulfamethoxazole as a Mono-Antibiotic Therapy for Hidradenitis Suppurativa. Journal of Cutaneous Medicine and Surgery, 28, 401-402. https://doi.org/10.1177/12034754241247520
[22]
Iannone, M., Janowska, A., Bartolomei, G., Puntoni, M., Oranges, T., Romanelli, M., et al. (2021) Systemic Antibiotics in Hidradenitis Suppurativa: Efficacy and Effects of Body Mass Index and Smoking Pack‐Year on the Response to Therapy. Dermatologic Therapy, 34, e14919. https://doi.org/10.1111/dth.14919
[23]
Barzilai, A., Toubiana, S., Dalal, A. and Baum, S. (2024) The Role of Piperacillin/Tazobactam in the Treatment of Hidradenitis Suppurativa. Journal of Dermatological Treatment, 35, Article 2363318. https://doi.org/10.1080/09546634.2024.2363318
[24]
Molinelli, E., Gioacchini, H., Marani, A., Rizzetto, G., Gambini, D., De Simoni, E., et al. (2024) Topical and Systemic Retinoids in the Management of Hidradenitis Suppurativa: A Comprehensive Literature Review. Dermatology and Therapy, 14, 1079-1091. https://doi.org/10.1007/s13555-024-01169-1
[25]
Boer, J. and Nazary, M. (2010) Long-term Results of Acitretin Therapy for Hidradenitis Suppurativa. Is Acne Inversa Also a Misnomer? British Journal of Dermatology, 164, 170-175. https://doi.org/10.1111/j.1365-2133.2010.10071.x
[26]
Cheng, C., Michaels, J. and Scheinfeld, N. (2008) Alitretinoin: A Comprehensive Review. Expert Opinion on Investigational Drugs, 17, 437-443. https://doi.org/10.1517/13543784.17.3.437
[27]
Masson, R., Park, S.E., Shih, T., Hogeling, M., Shi, V.Y. and Hsiao, J.L. (2024) Spironolactone in Hidradenitis Suppurativa: A Single-Center. International Journal of Women’s Dermatology, 10, e135. https://doi.org/10.1097/jw9.0000000000000135
[28]
Gangidi, S.V., Greene, R.K., Olsen, E., Jackson, S. and Nakamura, M. (2024) Efficacy of Spironolactone in Treating Hidradenitis Suppurativa in Women of Childbearing Age: A Single-Center Retrospective Analysis. International Journal of Women’s Dermatology, 10, e159. https://doi.org/10.1097/jw9.0000000000000159
[29]
Yi, R.C., Moran, S.K., Gantz, H.Y., Strowd, L.C. and Feldman, S.R. (2024) Biologics and Small Molecule Targeted Therapies for Pediatric Alopecia Areata, Psoriasis, Atopic Dermatitis, and Hidradenitis Suppurativa in the US: A Narrative Review. Children, 11, Article 892. https://doi.org/10.3390/children11080892
[30]
Molinelli, E., De Simoni, E., Candelora, M., Sapigni, C., Brisigotti, V., Rizzetto, G., et al. (2023) Systemic Antibiotic Therapy in Hidradenitis Suppurativa: A Review on Treatment Landscape and Current Issues. Antibiotics, 12, Article 978. https://doi.org/10.3390/antibiotics12060978
[31]
Kimball, A.B., Jemec, G.B.E., Alavi, A., Reguiai, Z., Gottlieb, A.B., Bechara, F.G., et al. (2023) Secukinumab in Moderate-to-Severe Hidradenitis Suppurativa (SUNSHINE and SUNRISE): Week 16 and Week 52 Results of Two Identical, Multicentre, Randomised, Placebo-Controlled, Double-Blind Phase 3 Trials. The Lancet, 401, 747-761. https://doi.org/10.1016/s0140-6736(23)00022-3
[32]
Stergianou, D., Kanni, T., Damoulari, C. and Giamarellos-Bourboulis, E.J. (2024) An Evaluation of Secukinumab for the Treatment of Moderate-to-Severe Hidradenitis Suppurativa. Expert Opinion on Biological Therapy, 24, 225-232. https://doi.org/10.1080/14712598.2024.2343112
[33]
Preda‐Naumescu, A., Ahmed, H.N., Mayo, T.T. and Yusuf, N. (2021) Hidradenitis Suppurativa: Pathogenesis, Clinical Presentation, Epidemiology, and Comorbid Associations. International Journal of Dermatology, 60, e449-e458. https://doi.org/10.1111/ijd.15579
[34]
Takeda, K., Kikuchi, K., Kanazawa, Y., Yamasaki, K. and Aiba, S. (2019) Ustekinumab Treatment for Hidradenitis Suppurativa. The Journal of Dermatology, 46, 1215-1218. https://doi.org/10.1111/1346-8138.15122
[35]
Yamanaka, K. (2023) New Treatment of Pyoderma Gangrenosum and Hidradenitis Suppurativa: A Review. The Journal of Dermatology, 51, 172-179. https://doi.org/10.1111/1346-8138.17031
[36]
Valenzuela-Ubiña, S., Jiménez-Gallo, D., Villegas-Romero, I., Rodríguez-Mateos, M.E. and Linares-Barrios, M. (2020) Effectiveness of Ustekinumab for Moderate-to-Severe Hidradenitis Suppurativa: A Case Series. Journal of Dermatological Treatment, 33, 1159-1162. https://doi.org/10.1080/09546634.2020.1776208
[37]
Kimball, A.B., Jemec, G.B.E., Sayed, C.J., Kirby, J.S., Prens, E., Ingram, J.R., et al. (2024) Efficacy and Safety of Bimekizumab in Patients with Moderate-to-Severe Hidradenitis Suppurativa (BE HEARD I and BE HEARD II): Two 48-Week, Radomised, Double-Blind, Placebo-Controlled, Multicentre Phase 3 Trials. The Lancet, 403, 2504-2519. https://doi.org/10.1016/s0140-6736(24)00101-6
[38]
Navrazhina, K., Frew, J.W., Grand, D., Williams, S.C., Hur, H., Gonzalez, J., et al. (2022) interleukin‐17RA Blockade by Brodalumab Decreases Inflammatory Pathways in Hidradenitis Suppurativa Skin and Serum. British Journal of Dermatology, 187, 223-233. https://doi.org/10.1111/bjd.21060
[39]
Osorio‐Gómez, G.F., Ortiz‐Álvarez, J., Diaz‐Ceca, D., Guijarro‐Sánchez, C., Conejo‐Mir Sánchez, J. and Fernández Crehuet, P. (2024) Brodalumab for Moderate-Severe Hidradenitis Suppurativa: An Open‐Label Multicentric Cohort Study in Real Clinical Practice. Australasian Journal of Dermatology, 65, 254-259. https://doi.org/10.1111/ajd.14267
[40]
Kanni, T., Zenker, O., Habel, M., Riedemann, N. and Giamarellos-Bourboulis, E.J. (2018) Complement Activation in Hidradenitis Suppurativa: A New Pathway of Pathogenesis? British Journal of Dermatology, 179, 413-419. https://doi.org/10.1111/bjd.16428
[41]
Giamarellos‐Bourboulis, E.J., Argyropoulou, M., Kanni, T., Spyridopoulos, T., Otto, I., Zenker, O., et al. (2020) Clinical Efficacy of Complement C5a Inhibition by IFX‐1 in Hidradenitis Suppurativa: An Open‐Label Single‐Arm Trial in Patients Not Eligible for Adalimumab. British Journal of Dermatology, 183, 176-178. https://doi.org/10.1111/bjd.18877
[42]
Husein-ElAhmed, H. and Husein-ElAhmed, S. (2024) Comparative Efficacy and Therapeutic Positioning of Biologics in Hidradenitis Suppurativa: A Systematic Review with Network Meta-Analysis of Randomised Trials. Indian Journal of Dermatology, Venereology and Leprology, 90, 302-310. https://doi.org/10.25259/ijdvl_665_2023
[43]
Ok, M.T., Googe, P.B., Sayed, C.J., Burkhart, C., Gulati, A.S. and Nieman, E.L. (2024) The Successful Use of Upadacitinib as Monotherapy for Hidradenitis Suppurativa and Ulcerative Colitis in the Setting of Refractory Disease. Pediatric Dermatology, 42, 353-357. https://doi.org/10.1111/pde.15759
[44]
Kozera, E., Flora, A. and Frew, J.W. (2022) Real-World Safety and Clinical Response of Janus Kinase Inhibitor Upadacitinib in the Treatment of Hidradenitis Suppurativa: A Retrospective Cohort Study. Journal of the American Academy of Dermatology, 87, 1440-1442. https://doi.org/10.1016/j.jaad.2022.07.047
[45]
Lyons, A.B., Townsend, S.M., Turk, D., Narla, S., Baah, N. and Hamzavi, I.H. (2020) Laser and Light-Based Treatment Modalities for the Management of Hidradenitis Suppurativa. American Journal of Clinical Dermatology, 21, 237-243. https://doi.org/10.1007/s40257-019-00491-1
[46]
Alikhan, A., Sayed, C., Alavi, A., Alhusayen, R., Brassard, A., Burkhart, C., et al. (2019) North American Clinical Management Guidelines for Hidradenitis Suppurativa: A Publication from the United States and Canadian Hidradenitis Suppurativa Foundations. Journal of the American Academy of Dermatology, 81, 76-90. https://doi.org/10.1016/j.jaad.2019.02.067
[47]
Highton, L., Chan, W., Khwaja, N. and Laitung, J.K.G. (2011) Treatment of Hidradenitis Suppurativa with Intense Pulsed Light: A Prospective Study. Plastic and Reconstructive Surgery, 128, 459-466. https://doi.org/10.1097/prs.0b013e31821e6fb5
[48]
Strobel, A., Schultheis, M., Staubach, P., Grabbe, S., Mann, C., Hennig, K., et al. (2024) Real‐World Effectiveness and Safety of the Laight‐Therapy in Patients with Hidradenitis Suppurativa. JDDG: Journal der Deutschen Dermatologischen Gesellschaft, 22, 936-945. https://doi.org/10.1111/ddg.15403
[49]
Janse, I., Bieniek, A., Horváth, B. and Matusiak, Ł. (2016) Surgical Procedures in Hidradenitis Suppurativa. Dermatologic Clinics, 34, 97-109. https://doi.org/10.1016/j.det.2015.08.007
[50]
Krajewski, A., Alsayed, A., Capek, A., Casey, K. and Chandawarkar, R. (2024) Surgical Management of Hidradenitis Suppurativa. Plastic and Reconstructive Surgery-Global Open, 12, e5860. https://doi.org/10.1097/gox.0000000000005860
[51]
Wang, Y., Han, C. and Wang, X. (2023) Advances in Surgical Treatment of Hidradenitis Suppurative. Journal of Zhejiang University (Medical Sciences), 52, 795-801. https://doi.org/10.3724/zdxbyxb-2023-0326
[52]
Minagawa, S., Araya, J., Watanabe, N., Fujimoto, S., Watanabe, J., Hara, H., et al. (2022) Real-Life Effectiveness of Dupilumab in Patients with Mild to Moderate Bronchial Asthma Comorbid with CRSwNP. BMC Pulmonary Medicine, 22, Article No. 258. https://doi.org/10.1186/s12890-022-02046-3