Rotational therapy with TNF-alpha blockers for recalcitrant hidradenitis suppurativa.

摘要

Hidradenitis suppurativa (HS) can be a very disabling skin condition due to progressive inflammation, secondary infection and scarring of skin areas rich in apocrine glands [1]. In a previous report, we highlighted the unstable long-term effect of infliximab in severe HS [2]. Two of these seven previously reported patients affected by severe HS and treated with infliximab 5 mg/kg plus methotrexate, in whom the good response was lost after 70 and 82 weeks of uninterrupted therapy respectively, were chosen for rotational anti-TNF-a therapy [2]. In patient #1, the extension of the disease was a contraindication for surgical therapy. In patient #2, wide surgical excision in both axillae was performed in 1997 and 2002, with relapse of the HS lesions in 2005. Both patients were scheduled to receive adalimumab as second line therapy at 40 mg s.c. at days 0, 4, 7, 14 and every other week as maintenance. Due to the poor response to adalimumab in patient #1, etanercept was chosen as third line therapy at 50 mg s.c. twice weekly for 12 weeks and 25 mg twice weekly as maintenance.