John R. Ingram Interventions for Hidradenitis Suppurativa Updated Summary of an Original Cochrane Review . JAMA Dermatology Published online March 29, 2017
More than 50 hidradenitis suppurativa (HS) interventions are documented, including topical, systemic, and surgical interventions,many with a relatively weak evidence base. This synopsissummarizes a Cochrane review on HS published in 20151,2 andhas been updated with more recent randomized clinical trials(RCTs).
Summary of Findings
A single RCT of 30 participants investigated topical therapy for S,comparingclindamycin1%solution withvehicle solution.Therewereconflicting results from nonstandard outcome measure instrumentsbut active treatment was well-tolerated.
Oral tetracycline 500 mg twice daily was superior to clindamycin1% solution in a trial of 46 participants in terms of participant’sglobal assessment, but there was no difference in otheroutcome measures (low-quality evidence). A crossover study of
ethinylestradiol and cyproterone acetate vs ethinylestradiol andnorgestrel showed no difference between the groups but was difficultto interpret because of nonstandard outcome measures.
Regarding biologic therapy, adalimumab 40 mg weekly produceda2.8point
reduction in Dermatology Life Quality Index (DLQI)score compared with placebo at 12 to 16 weeks (Figure), a significantdifference but smaller than the DLQI minimal clinically importantdifference of 4 points.3 There was no increase in serious adverseevents (relative risk [RR], 2.00; 95% CI, 0.38-10.44) orinfections (RR, 0.94; 95% CI, 0.55-1.62) compared with placebo.Adalimumab40mgevery otherweekwas ineffective, aswasetanercept50mgtwiceweekly. In a trial completed by 33participants, infliximab5mg/kg atweeks0, 2, and 6 decreased DLQI by 8.4 points
compared with placebo (moderate-quality evidence). The anti–interleukin-1 agent anakinra did not improve DLQI scores (lowqualityevidence).
Wound healing adjuncts were tested in 2 RCTs. Insertion of agentamicin-collagen sponge prior to primary closure of local excisionswas compared with primary closure alone in 200 patients,with no difference in recurrence or complication rates. Another RCT treated all patients with the combination of oral clindamycinand rifampicin twice daily for 10 weeks and randomized half of the43 participants to receive hyperbaric oxygen therapy for the first 4weeks. There was no significant difference in DLQI, with evidencequality downgraded to low, in part due to imprecision. Randomizedclinical trials of intense pulsed light, neodymium-doped yttriumaluminum garnet laser and photodynamic therapy suggested benefit,
but evidence quality was downgraded to “low” or “very low”due to imprecision and performance bias resulting from withinparticipantdesigns with no sham controls. Staphage lysate, preparedfrom bacteriophage lysis of Staphylococcus aureus, was
investigated in a small RCT in 1987, but no studies have been performedsubsequently and there is insufficient evidence to recommend
a change in practice.