Table 1.
Recent studies of non-biologic medical treatments for hidradenitis suppurativa (2019–2021)
| Treatment | Sample size (N) | LOE (type of study)a | Key message | First author (year) |
|---|---|---|---|---|
| Topical therapy | ||||
| Topical ichthammol 10% twice daily for 10 days | 20 | 4 (case-series study) | Decreased abscess size with no adverse effects | Fisher (2020) [13] |
| Topical resorcinol 15% cream once daily for 12 weeks | 61 | 4 (interventional prospective study) | Decrease in IHS4 at 4 weeks (p < 0.001) and 12 weeks (p < 0.05) | Molinelli (2020) [16] |
| Topical 15% resorcinol | 92 | 4 (cross-sectional study) | 15% of patients were satisfied and 84.8% would recommend the treatment | Docampo- Simón (2021) [17] |
| Intralesional and systemic steroids | ||||
| Intralesional triamcinolone 10 mg/mL, 40 mg/mL, and normal saline over a 14-day period | 32 | 2 (double-blind, randomized, placebo-controlled trial) | No significant difference in days to HS inflammatory lesion clearance, pain reduction at day 5, or patient satisfaction | Fajgenbaum (2020) [21] |
| Intralesional ultrasound-guided combined treatment with triamcinolone 40 mg plus lincomycin 600 mg | 36 | 4 (interventional prospective study) | Decrease in mean VAS values for pain (p = 0.027) Bodily Pain scale of the Short-Form Health Survey (SF-36) improved at 4 weeks (p < 0.001) | Fania (2020) [22] |
| Two injections at baseline and after 2 weeks | ||||
| Intralesional triamcinolone 40 mg/mL and lincomycin 300 mg/mL therapy under ultrasound guidance | 8 | 4 (interventional prospective study) | Treatment combination shows statistically significant reduction of HS symptoms and pain | Caposiena Caro (2020) [23] |
| Two injections at baseline and after 4 weeks | ||||
| Intralesional ultrasound-guided triamcinolone 40 mg/mL once weekly for 12 weeks | 77 | 2 (interventional prospective study) | Decrease in IHS4 at 12 weeks (p < 0.001) Hurley stage negatively correlated with complete response for abscesses and draining fistulas at – 0.17 (p < 0.01) and −0.30 (p < 0.02) | Salvador- Rodriguez (2020) [24] |
| Intralesional corticosteroid injection (the most common corticosteroid applied was triamcinolone; dosage was between 0.5 and 1 mL) | 98 | 4 (observational, retrospective study) | Complete response in 70.4% of lesions, partial response in 25.2% of lesions, no response in 4.4% of lesions Improved response rates if previously evaluated with ultrasound |
García-Martínez (2021) [25] |
| Tumescent triamcinolone infiltration 250 mL of saline, 25 mL of 1% lidocaine with epinephrine, and 120 mg of triamcinolone in the form of a 40 mg/mL solution delivered once | 1 | 5 (case report) | Efficacy of tumescent triamcinolone injection for the treatment of aggressive/recalcitrant HS in the setting of Crohn’s disease | Dautriche (2020) [26] |
| Intralesional methylprednisolone versus oral prednisone in patients treated with adalimumab 1. Methylprednisolone 40 mg injection twice in 2-week intervals 2. Oral prednisone 10 mg daily for 8–12 weeks |
38 | 2 (interventional prospective study) | Efficacy of intralesional or low-dose systemic prednisone in combination with adalimumab in relapsing HS in improving IHS4 DLQI and pain | Arenbergerova (2021) [27] |
| Antibiotic therapy | ||||
| Tetracyclines: Oral tetracycline 500mg twice daily, doxycycline 100 mg twice daily, lymecycline 300 mg twice daily for 4 months | 108 | 2 (prospective study) | Improvement in HSS at follow-up (p < 0.0001) | Jorgensen (2021) [33] |
| Combination therapy with clindamycin 300 mg and rifampicin 300 mg twice daily for 6 months | 54 | 4 (open-label, single-group, prospective study) | Improvement in HSS (p < 0.001) | Yao (2021) [37] |
| Combination therapy with oral clindamycin (600 mg daily) and rifampicin (600 mg daily) for 10 weeks | 20 (aged ≥16 years) | 4 (pilot prospective study) | Reduction in Sartorius score and number of exacerbations after treatment (p = 0.001) | Bettoli (2021) [38] |
| Tetracyclines and clindamycin plus rifampicin: Oral tetracyclines (tetracycline 500 mg twice daily, doxycycline 100 mg once daily, minocycline 100 mg once daily) or clindamycin 300 mg twice daily with rifampicin 600 mg once daily for 12 weeks | 283 | 2 (prospective cohort study) | Decrease in IHS4 in the tetracycline group (p < 0.001) and the clindamycin and rifampicin combination group (p < 0.001) | van Straalen (2021) [39] |
| Tetracycline (lymecycline 300 mg daily) versus combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) for 10 weeks | 52 | 3 (retrospective study) | Improvement in IHS4, VAS, and DLQI baseline (p < 0.001), particularly in the tetracycline group | Caposiena Caro (2021) [40] |
| Clindamycin 150 mg four times daily versus clindamycin 150 mg four times daily plus rifampicin 300 mg twice daily for 8 weeks | 60 | 3 (retrospective comparative study) | Improvement in IHS4 score, DLQI (p = 0.037) and VAS (p = 0.038), particularly in the clindamycin monotherapy group Reductions in nodule and abscess counts were similar between the groups Marked decrease in the number of draining tunnels in the clindamycin monotherapy group (p = 0.002) |
Caposiena Caro (2019) [41] |
| Clindamycin 300 mg twice daily for 12 weeks | 31 | 4 (retrospective study) | Reduction in disease severity parameters (p < 0.01) | Rosi (2019) [42] |
| Oral combination of rifampin (10 mg/kg once daily), moxifloxacin (400 mg once daily), and metronidazole (250– 500 mg three times daily) [RMoM] treatment | 28 (19 patients were treated for 6 weeks by RMoM, followed by 4 weeks of RMo alone, then by cotrimoxazole after remission) | 4 (prospective, open-label, non-comparative cohort study) | Reduction in Sartorius score at 12 weeks (p = 6 × 10−6) 75% of patients reaching clinical remission (p = 0.049) Decrease in the number of flares per year flares (p = 10−5) |
Delage (2020) [44] |
| Dapsone 50–200 mg/day (mostly 100 mg/day) for 2 weeks-7 months | 24 | 4 (case series) | Improvement was seen in 9 of 24 (38%) treated patients, whereas 15 of 24 (62%) did not experience any improvement. Rapid recurrence after treatment cessation is a concern | Yazdanyar (2011) [49] |
| Dapsone 50 mg once daily titrated up according to response and tolerability: 18 patients (72%) received 100 mg, one patient (4%) received 150 mg, and one patient (4%) received 200 mg; 5 patients (20%) remained on 50 mg | 25 | 4 (retrospective review study) | Subjective clinical improvement was seen in 16 (64%) patients. Dapsone appears to be an effective and well-tolerated treatment option for HS in patients with Hurley stage I and II disease | Murray (2020) [50] |
| Hormonal therapies | ||||
| Spironolactone 75 mg once daily over a 7-month period | 67 | 4 (single-center chart retrospective review) | Patients achieved significant disease improvement with regard to pain (Δ – 1.5; p = 0.01), inflammatory lesions (Δ – 1.3; p = 0.02), and HS-PGA score (Δ – 0.6; p < 0.001). No change was found for Hurley stage and fistulas. There was no difference in improvement between subjects who received < 75 mg of spironolactone and those who received > 100 mg daily | Golbari (2019) [55] |
| Spironolactone 100 mg (n = 22) or 50 mg (n = 4) daily Mean 6 months (range 2–17 months) | 26 | 4 (retrospective chart review) | Spironolactone was effective in 35% of patients, with a reduction in DLQI of > 5 | Quinlan (2020) [56] |
| Metformin (mean dose 1.5 g once daily over a mean period of 11 months) | 53 | 4 (retrospective chart review) | Subjective clinical response was seen in 68% of patients, with 19% of these having quiescent disease with metformin monotherapy. 25% had no improvement Gastrointestinal adverse effects in 11% of patients | Jennings (2020) [57] |
| Metformin | 16 | 4 (retrospective chart review) | For some pediatric patients, metformin as an adjunctive therapy may help improve the control of HS with minimal adverse effects | Moussa (2020) [59] |
| Retinoids | ||||
| Isotretinoin | 209 | 4 (retrospective chart review) | Demonstrates a 35.9% response rate based on patients’ outcome assessment, while 64.1% of patients reported no response. When comparing responders with non-responders, responders were more likely to have a history of pilonidal cyst (p = 0.024). | Patel (2021) [62] |
| Various combination therapies | 31 | 4 (retrospective chart review) | Suggests that combination therapy with isotretinoin/spironolactone for mild disease, isotretinoin or doxycycline with adalimumab for moderate disease, and cyclosporine/adalimumab for severe disease appears to be an effective method of HS management, however no statistical results are provided | McPhie (2019) [63] |
| Others | ||||
| Oral therapy with capsules containing 90 mg of zinc gluconate and 30 mg of nicotinamide once daily for 90 days | 92 | 3 (controlled retrospective clinical study) | Demonstrate a significant reduction in the number and mean duration of acute flares in the treated versus control groups. Patients in the treated group correspondingly reported a marked reduction in mean VAS, DLQI, and IHS4 scores compared with the control group at both 12 and 24 weeks (p < 0.005) | Molinelli (2020) [67] |
| Verapamil 240 mg three times daily for 2 months | 1 | 5 (case report) | When verapamil was stopped, the lesions recurred within 1.5 months. The patient resumed taking verapamil before and after remission occurred | Laroche (2019) [68] |
| Thalidomide 50 mg daily for 2 months then 100 mg daily for 4 months | 6 | 5 (case report) | Demonstrates the potential efficacy of daily treatment with thalidomide 100 mg for 4 months in patients with severe inflammatory HS showing failure of conventional treatments based on recent published guidelines | Hotz (2019) [69] |
LOE level of evidence, IHS4 International Hidradenitis Suppurativa Severity Score System, HS hidradenitis suppurativa, VAS visual analog scale, DLQI Dermatology Life Quality Index, HSS Hidradenitis Suppurativa Score, PGA Physician Global Assessment
a
1 = randomized controlled trial; 2 = prospective cohort study; 3 = case-control study, retrospective cohort study; 4 = case series, uncontrolled cohort study; 5 = expert opinions, case report