A Disease-Modifying Approach for Advanced Hidradenitis Suppurativa (Regimen with Metformin, Liraglutide, Dapsone, and Finasteride): A Case Report

Abstract

Hidradenitis suppurativa (HS) is a challenging skin disease with limited therapeutic options. Obesity and metabolic syndrome are being increasingly implicated and associated with younger ages and greater metabolic severity. A 19-year-old female with an 8-year history of progressively debilitating cicatricial HS disease presented with obesity, profound anemia, leukocytosis, increased platelet count, hypoalbuminemia, and elevated liver enzymes. A combination of metformin, liraglutide, levonorgestrel-ethinyl estradiol, dapsone, and finasteride was initiated. Acute antibiotic use for recurrences and flares could be slowly discontinued. Over the course of 3 years on this regimen, the liver enzymes normalized in 1 year, followed in2 years by complete resolution of the majority of the hematological and metabolic abnormalities. The sedimentation rate reduced from over 120 to 34 mm/h. She required 1 surgical intervention for perianal disease after 9 months on the regimen. Flares greatly diminished in intensity and duration, with none in the past 6 months. Right axillary lesions have completely healed with residual disease greatly reduced. Chiefly abdominal lesions are persistent. She was able to complete high school from home, start a job, and resume a normal life. Initial weight loss of 40 pounds was not maintained. The current regimen is being well tolerated and continued.

The efficacy and use of finasteride in women: a systematic review

“…Six patients improved significantly and three of them had completely healed lesions, but the study lacked gender data . A report showed no new HS lesions 3 months following finasteride treatment, while another showed faster healing lesions (3 weeks vs. 6 months) and ultimately no new lesions after 3 years . Case series of girls with HS (6–11 years old) treated with finasteride (1–5 mg/day) for 24 months had overall improvement of disease, with a reduction in frequency and intensity of flares …”

“…A couple case series examined finasteride (5 mg/day) for hidradenitis suppurativa (HS) therapy . Five women and two men with HS unresponsive to antibiotics were treated with finasteride.…”

“…Case reports have observed successful finasteride administration for improving lesions of hidradenitis suppurativa . Other reports highlighted finasteride use in the alleviation of chronic migraines and an association between finasteride cessation and reduction of seizures .…”

“…73 A report showed no new HS lesions 3 months following finasteride treatment, 74 while another showed faster healing lesions (3 weeks vs. 6 months) and ultimately no new lesions after 3 years. 75 Case series of girls with HS (6-11 years old) treated with finasteride (1-5 mg/day) for 24 months had overall improvement of disease, with a reduction in frequency and intensity of flares. 76 Central serous chorioretinopathy Central serous chorioretinopathy (CSCR) is an acquired idiopathic chorioretinal disorder characterized by exudative detachment of the retina and/or retinal pigment epithelium (RPE).…”

“…72 Hidradenitis suppurativa A couple case series examined finasteride (5 mg/day) for hidradenitis suppurativa (HS) therapy. 42,[73][74][75][76] Five women and two men with HS unresponsive to antibiotics were treated with finasteride. Six patients improved significantly and three of them had completely healed lesions, but the study lacked gender data.…”