Is there a role for infliximab in the current therapy of hidradenitis suppurativa? A report of three treated cases.

BACKGROUND Hidradenitis suppurativa is one of the follicular occlusion diseases favoring the flexural areas of the body. Because of the past failure of medical therapy, surgery is today the definitive therapeutic approach. There is a need for effective medical anti-inflammatory therapy to control the disease and minimize the pathologic and socioeconomic consequences of the disease process. Generally the patients fail to respond to topical or systemic antibiotics and retinoids. Temporary responses are achieved with intralesional steroids and cyclosporin. METHODS The association of hidradenitis suppurativa with inflammatory bowel disease permitted the opportunity to utilize infliximab and to observe not only its impact on the bowel, but also skin. RESULTS Infliximab dramatically and favorably impacted on three cases of hidradenitis, but also in one of the patients who also had pyoderma gangrenosum. CONCLUSIONS Infliximab appears to be an effective medical approach to the management of hidradenitis suppurativa and also to prepare the patient for "curative" surgery. However, one must be cognizant of the potential of acquired drug resistance or adverse drug reactions, which can be minimized by "no vacations" from this systematic therapy and the use of methotrexate to minimize the above potential problems.