Hidradenitis suppurativa treated with combination of infliximab and dapsone

Abstract

Hidradenitis suppurativa (HS) is chronic infl ammatory disease characterized by recurrent painful nodules, which leads to forming an abscess and sinus tracts, together with pustulation and hypertrophic scarring in the areas of apocrine sweat glands. Systemic and local antibiotic therapy, together with corticoid therapy, sulphonates, retinoids and surgical treatment with incisions and drainage belongs to actual treatment possibilities. Biological therapy represents the absolute peak in the treatment last years, mostly TNFα-inhibitors. Even though their very good short term effect is described, long term keeping up the good long effect of the treatment is not achieved with satisfaction. This is the reason to reach for traditional therapeutic possibilities combined with biological treatment in cases of torpid and resistive disease. In the following article a case report of a patient with hidradenitis suppurativa treated subsequently with combination of TNFα-inhibitors and dapson (Fig. 6, Ref. 19 Hidradenitis suppurativa (HS) is chronic infl ammatory disease characterized by recurrent painful nodules, which leads to forming an abscess and sinus tracts, together with pustulation and hypertrophic scarring in the areas of apocrine sweat glands. It is spread evenly between both genders. Obesity and smoking belong to risk factors. Hormonal factors are also described, which is supported by the fact, that the disease can be mitigated in gravidity. Various infections can worsen the existing manifestations. In clinical fi ndings painful nodules and fi stulas draining pus are seen. Predilection areas of the disease are the areas with apocrine glands (axillar and inguinal areas, perigenital and perianal area, submammar space), ectopic nodules can be located anywhere on the body. Sanation is accompanied with forming of hypertrophic scars, which can lead to dermogenous contractures. Systemic and local antibiotic therapy, together with corticoid therapy, sulfones, retinoids and surgical treatment with incisions and drainage belongs to actual treatment possibilities. Complete restoration is in the present possible only by removing the skin with apocrinne sweat glands in the full thickness, which can result in cosmetic disturbing features, dermogennous contractures and with predisposed individuals the new focus can appear in other part rich in apocrine sweat glands. Biologics, mainly TNFα-inhibitors, are even more often fi nding their place in the treatment of other diseases, where an important role is played by tumor necrosis factor alpha (TNFα). Hidradenitis suppurativa is one of these diseases. Case report53-years old female with two years history of hidradenitis suppurativa was admited at the Clinic of Dermatovenerology in Bratislava in March 2009. Painful nodules and many fi stulas in the medial part of thighs (Figs 1 and 2), left gluteal and submammar area were dominating the clinical fi ndings, ectopic focuses were found on the front side of the body. Axillar, perigenital and inguinal areas were not affected. Pati...

Dapsone in Hidradenitis Suppurativa: A Systematic Review

“…Patients who were given additional treatment did not show any improvement and treatment with dapsone had to be discontinued in two cases where side effects were reported. Adverse events were reported in 10 patients Dizziness, tiredness, nausea, anemia, headache, low hemoglobin, general malaise, gloominess Kozub and Simaljakova (2012) [ 33 ] 1 female patient Age: 53 years Case report 4 Not reported Infliximab and dapsone 100–200 mg/day for 21 weeks The patient showed a clinically significant improvement with the normalization of C-reactive protein level achieved No side effects Bashyam et al (2020) [ 34 ] 19 patients Retrospective case series 4 Moderate—severe HS Dapsone [+ adalimumab in 12 cases] 25–100 mg/day for 1–3 months Clinically significant improvement was observed in 3 (15.8%) patients while the condition of 10 (52.6%) patients slightly improved. The remaining 6 (31.6%) patients had no change in their health status.…”

“…One study reported the need for maintenance dosage therapy to sustain positive patient outcomes [ 31 ]. Although most of the studies did not report the anti-inflammatory marker levels during HS treatment, Kozub and Simaljakova reported that dapsone contributed to the normalization of C-reactive protein levels [ 33 ].…”

Combination Treatment for Hidradenitis Suppurativa

“…A single case report of dapsone and infliximab in combination has also been trailed in a patient with HS with significant clinical improvement of lesions. 28 Another case series of sirolimus used as a rescue therapy in combination to tumor necrosis factor inhibitors demonstrated improvement in 78% of patients with severe refractory HS. 29 HS is primarily a chronic inflammatory disease affecting apocrine glands.…”