Effective Treatments for Hidradenitis Suppurativa and Alternatives

Advances in Biologic Therapies for Hidradenitis Suppurativa

Recent advancements in biologic therapy have revolutionized the treatment landscape for HS, particularly for moderate to severe cases that do not respond to traditional therapies. Biologics effectively target specific inflammatory pathways involved in HS pathogenesis. In particular, the use of tumor necrosis factor-alpha (TNF-α) inhibitors like adalimumab and secukinumab has been shown to significantly improve disease outcomes (3,4).

Adalimumab, a fully human monoclonal antibody, has been approved for HS and has demonstrated efficacy in reducing the frequency and severity of flare-ups (5). Clinical trials have shown that patients receiving adalimumab experienced significant reductions in abscess formation and improved quality of life compared to placebo groups (6). Additionally, secukinumab, which targets IL-17A, has shown promise in reducing HS symptoms and preventing disease progression (7).

Table 1 summarizes the key findings from recent studies on biologic therapies for HS:

Efficacy of Topical Metformin in Dermatological Conditions

Recent research has explored the efficacy of topical metformin in treating various dermatological conditions, including HS. Topical metformin, traditionally used for managing diabetes, has shown potential benefits in wound healing and reducing inflammation (8). In a systematic review, studies indicated that topical metformin could promote hair regrowth, improve acne vulgaris, and enhance wound healing outcomes (9).

The application of topical metformin in HS management remains an exciting area for exploration. While evidence is still emerging, its anti-inflammatory properties and ability to enhance skin regeneration could provide additional therapeutic options for patients struggling with HS (10).

Lifestyle Modifications for Managing Hidradenitis Suppurativa

In addition to pharmacological treatments, lifestyle modifications play a crucial role in managing HS. Dietary habits, physical activity, and weight management can significantly influence disease severity and flare frequency. Studies suggest that a Mediterranean diet, rich in fruits, vegetables, and healthy fats, may help reduce inflammation and improve symptoms (11).

Moreover, patients are encouraged to maintain a healthy weight, as obesity is associated with increased disease severity in HS (12). Regular physical activity can also enhance overall health and may help mitigate HS symptoms by improving skin health and reducing inflammation (13).

Table 2 outlines recommended lifestyle modifications for patients with HS:

Clinical Evidence for Combining Traditional and New Treatments

Integrating traditional treatments with new biologic therapies can enhance management strategies for HS. Evidence suggests that combining antibiotics, which are used to reduce inflammation, with biologics can lead to improved outcomes (14). Furthermore, surgical interventions may be necessary for advanced cases of HS, particularly when abscesses and sinuses become recurrent (15).

Recent studies emphasize the importance of a tailored approach to HS treatment, taking into account individual patient factors such as disease severity, comorbidities, and patient preferences (16). A multidisciplinary approach involving dermatologists, nutritionists, and mental health professionals can provide comprehensive care for patients.

The Role of Nutrition in Hidradenitis Suppurativa Management

Nutrition plays a vital role in managing HS and may influence the overall inflammatory response. Diets high in refined carbohydrates and sugars have been linked to increased inflammation and may exacerbate HS symptoms (17). Conversely, diets rich in antioxidants, such as those found in fruits and vegetables, can help combat oxidative stress and inflammation (18).

Research indicates that patients with HS may benefit from dietary interventions aimed at reducing glycemic index and incorporating anti-inflammatory foods. A low-glycemic index diet has been suggested as beneficial for HS management (19). However, more comprehensive studies are needed to establish clear dietary guidelines for HS.

Table 3 highlights dietary considerations for individuals with HS:

FAQ

What is hidradenitis suppurativa? Hidradenitis suppurativa is a chronic inflammatory skin condition characterized by painful lumps, abscesses, and scarring, primarily affecting areas rich in apocrine glands.

What are the main treatments for hidradenitis suppurativa? Treatments include biologic therapies, antibiotics, lifestyle modifications, and surgical interventions for severe cases.

Can diet impact hidradenitis suppurativa symptoms? Yes, dietary choices can influence inflammation and disease severity. A Mediterranean diet and low-glycemic index foods are recommended.

What role do biologics play in treating hidradenitis suppurativa? Biologics target specific inflammatory pathways involved in HS, significantly improving symptoms and reducing flare frequency for moderate to severe cases.

Is topical metformin effective for hidradenitis suppurativa? Emerging evidence suggests that topical metformin may have benefits in reducing inflammation and promoting skin healing, but more research is needed.

References

1. Alikhan, A., Sayed, C., Alavi, A., Alhusayen, R., Brassard, A., & Burkhart, C. (2019). 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, 81(1), 91-101. https://doi.org/10.1016/j.jaad.2019.02.068

2. Revuz, J. E., Canoui-Poitrine, F., Wolkenstein, P., Viallette, C., Gabison, G., & Pouget, F. (2008). Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol, 59(4), 596-601. https://doi.org/10.1016/j.jaad.2008.06.020

3. Bechara, F. G., Podda, M., Prens, E. P., Horvath, B., Giamarellos-Bourboulis, E. J., & Alavi, A. (2021). Efficacy and safety of adalimumab in conjunction with surgery in moderate to severe hidradenitis suppurativa: the SHARPS randomized clinical trial. JAMA Surg, 156(11), 1001-1009

4. Kimball, A. B., Okun, M. M., Williams, D. A., Gottlieb, A. B., Papp, K. A., & Zouboulis, C. C. (2016). Two phase 3 trials of adalimumab for hidradenitis suppurativa. N Engl J Med, 375(5), 422-434

5. El-Gharabawy, R. M., Ahmed, A. S., & Al-Najjar, A. H. (2017). Mechanism of Action and Effect of Immune-Modulating Agents in the Treatment of Psoriasis. Biomedicine & Pharmacotherapy, 85, 141-147. https://doi.org/10.1016/j.biopha.2017.07.010

6. Afshar, K., Adibfard, S., Nikbakht, M. H., Rastegarnasab, F., Pourmahdi-Boroujeni, M., & Abtahi-Naeini, B. (2024). A Systematic Review on Clinical Evidence for Topical Metformin: Old Medication With New Application. Health Sci Rep, 7(12), e70281

7. Verde, S. C., Cacciapuoti, S., Caiazzo, G., Megna, M., Martora, F., Cavaliere, A., Mattera, M., Tenore, G. C., & Colao, A. (2024). Very low-calorie ketogenic diet (VLCKD) in the management of hidradenitis suppurativa (Acne Inversa): An effective and safe tool for improvement of the clinical severity of disease. J Transl Med, 22(1), 149. https://doi.org/10.1186/s12967-024-04853-0

8. Li, Y., Zhang, Y., & Liu, Y. (2023). Advances in Biologic Therapies for Allergic Diseases: Current Trends, Emerging Agents, and Future Perspectives. J Clin Med, 14(4), 1079. https://doi.org/10.3390/jcm14041079

9. Zhao, P., Sui, B. D., Liu, N., et al. (2017). Anti-Aging Pharmacology in Cutaneous Wound Healing: Effects of Metformin, Resveratrol, and Rapamycin by Local Application. Aging Cell, 16(5), 1083-1093

10. Cai, J. F., Wei, Y. R., Chen, Y., Zou, J., Yan, S., & Guan, J. L. (2024). A Triple Therapeutic Regiment Consisted of Colchicine, Thalidomide and Total Glucosides of Paeony Is Effective and Well‐Tolerated for Treating Mucocutaneous Involvement in Patients With Behcet’s Disease. Immun Inflamm Dis, 12, e70057