Funding sources None.
Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review
Article first published online: 30 JAN 2013
© 2012 The Authors. BJD © 2012 British Association of Dermatologists
British Journal of Dermatology
Volume 168, Issue 2, pages 243–252, February 2013
How to Cite
Blok, J.L., van Hattem, S., Jonkman, M.F. and Horváth, B. (2013), Systemic therapy with immunosuppressive agents and retinoids in hidradenitis suppurativa: a systematic review. British Journal of Dermatology, 168: 243–252. doi: 10.1111/bjd.12104
Conflicts of interest B.H. has received an unrestricted educational grant from Abbott B.V. (the Netherlands) and an Investigator Initiated Study grant from Janssen-Cilag B.V. (the Netherlands).
- Issue published online: 30 JAN 2013
- Article first published online: 30 JAN 2013
- Accepted manuscript online: 27 OCT 2012 01:55AM EST
- Accepted for publication 17 October 2012
Hidradenitis suppurativa (HS) is a difficult disease to treat. Although the pathogenesis of this inflammatory skin disease is largely unknown, the important role of the immune system has been demonstrated in both experimental and clinical studies. Clinicians are therefore increasingly prescribing systemic treatments with immunosuppressive agents, but the more traditionally used systemic retinoids, especially isotretinoin, also remain relatively common therapies. In order to provide an overview of all currently available systemic immunosuppressive agents and retinoids for the treatment of HS, a systematic search was performed using the Medline and Embase databases. All published papers concerning systemic retinoids or immunosuppressive treatments for HS in adults were included. The primary endpoints were the percentages of significant responders, moderate responders and nonresponders. Other endpoints were the relapse rate and adverse events. In total 87 papers were included, comprising 518 patients with HS who were treated with systemic retinoids, biological agents or another immunosuppressive agents, including colchicine, ciclosporin, dapsone or methotrexate. The highest response rates were observed with infliximab, adalimumab and acitretin. Overall, the quality of evidence was low and differed between the agents, making direct comparisons difficult. However, based on the amount of evidence, infliximab and adalimumab were the most effective agents. Acitretin was also effective in HS, although the quality of the evidence was low. The therapeutic effect of isotretinoin is questionable. Randomized controlled trials are needed to confirm the effectiveness of acitretin, and to identify the most effective immunosuppressive agents in HS.