Treatment of recalcitrant hidradenitis suppurativa with oral ciclosporin.

Conflict of interest: none declared. Hidradenitis suppurativa (HS) is a disorder of the terminal follicular epithelium within apocrine‐bearing skin. The disease may run an unremitting course and result in significant physical and psychological morbidity. There are several medical and surgical approaches to managing HS, although evidence from randomised controlled trials is scarce. Ciclosporin has been reported anecdotally twice for the treatment of HS; two further cases are described here. A 38‐year‐old woman was referred with a 20‐year history of recurrent groin abscesses. Previous treatments included multiple surgical‐drainage procedures and antibiotics. She was otherwise well. On examination she had large inflammatory lesions on the thighs and in the groin area, with scarring and sinus formation. Clinically the features were consistent with HS. Routine haematological and biochemical tests were normal. She was initially treated with controlled‐release minocycline 100 mg twice daily together with a reducing course of oral steroids, starting at prednisolone 30 mg daily. The disease flared once the steroids were discontinued and the patient received a pulse of 500 mg of intravenous methylprednisolone. Despite this, she required surgery to excise areas of inflammation on the right thigh and labia majora, and subsequently received oral clindamycin and clarithromycin and intralesional steroids with no real improvement. Hence ciclosporin was introduced at 4 mg/kg daily with appropriate monitoring. This was well‐tolerated, and after 3 months was reduced to 2 mg/kg daily. She has now been on this for 7 months and has had no severe episodes of inflammation during this period.