A prospective randomized controlled trial assessing the efficacy of adjunctive hyperbaric oxygen therapy in the treatment of hidradenitis suppurativa

Abstract

Hyperbaric oxygen therapy (HBOT) appears to enhance wound healing, increase bactericidal activity, and act synergistically with a number of antibiotics. The aim of this study was to evaluate the efficacy of HBOT as an adjunctive therapy in patients with hidradenitis suppurativa (HS) treated with a combination of systemic rifampicin and clindamycin. The study was a prospective, single-center, single-dose, open-label, randomized controlled clinical study of HBOT in patients with moderate to severe HS. Efficacy was measured by modified Sartorius score (SS), HS Severity Index (HSSI), Dermatology Life Quality Index (DLQI), and a visual analog scale (VAS) before treatment and after the completion of 4 and 10 weeks of treatment. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were also measured. Forty-three patients were enrolled in the study. More patients in the HBOT than in the control group showed a decrease of ≥50% from baseline parameters at week 10 for SS (100%), HSSI (100%), DLQI (95.5%), VAS (100%), ESR (100%), and CRP (72.7%). Clinically and statistically significant improvements from baseline were observed at 4 and 10 weeks in HSSI (P = 0.009 at both), SS (P = 0.021 at both), and DLQI (P = 0.044 at week 4, P = 0.009 at week 10). Adjunctive HBOT was considered to be effective in significantly improving antibiotic treatment of HS. The treatment was well tolerated, and no unexpected safety issues were identified.

Quality of life measurement in hidradenitis suppurativa: position statement of the European Academy of Dermatology and Venereology task forces on Quality of Life and Patient‐Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

“…38,39 There were five publications on surgical treatment, [40][41][42][43][44] one study on combination of surgical treatment with photodynamic therapy 45 and two other studies on photodynamic therapy. 46,47 There were three studies on antibiotics, [48][49][50] single studies on metformin, 51 PUVA, 52 hyperbaric oxygen therapy, 53 alitretinoin, 54 acitretin, 55 ankinra, 56 apremilast, 57 oral zinc gluconate combined with topical triclosan 58 and verapamil. 59 Detailed information on clinical trials that included ten or more HS patients is presented in Table 1.…”

Combination hyperbaric oxygen therapy and ustekinumab for severe hidradenitis suppurativa

“…HBOT‐induced local tissue hyperoxia also has antiinflammatory and bactericidal properties, which further enhance wound healing. HBOT has been described as an adjunctive treatment for adults with HS . There is one recent report of HBOT improving the efficacy of adalimumab therapy in an adult with HS .…”

Hyperbaric Oxygen Therapy and Quality of Life: A Systematic Review

“…HBOT is an excellent treatment for decompression injury, which is a risk of scuba immersion (1). Other abnormalities treated with HBOT include serious infections, air bubbles in blood vessels, chronic diabetic foot ulcers, and radiation injury (2). Some clinical trials proved that HBOT are useful in the treatment of severe common ischemic diabetic foot ulcer (3).…”

“…Age ± SD (Years) 1 Hidradenitis suppurativa (2) HBOT sessions 120 minutes, a period of compression in air for 20 minutes, followed by treatment at 2.4 atmospheres absolute (ATA) for 3 periods of 25 minutes separated by two 5-minute air breaks (mask off), followed by a decompression period of 15 minutes. 5 days/week for 4 weeks (20 treatment sessions, once per day except at weekends.…”