Treatment of severe hidradenitis suppurativa with infliximab in combination with surgical interventions

Funding sources: the department received a research grant from MSD to perform the retrospective chart analysis (this study). No other funding was provided. All study medication was paid from the regular hospital budget. Conflicts of interest: none declared. Madam, Hidradenitis suppurativa (HS) is a chronic recurrent skin disease characterized by painful abscesses, scars and sinus tract formation. Current treatment modalities such as topical antibacterial lotions, systemic antibiotics and corticosteroids achieve only temporary improvement.1, 2 Recently, treatment with the tumour necrosis factor (TNF)‐α inhibitors infliximab and adalimumab has shown promising results in patients with severe HS.3–6 Still, many authors claim that surgical intervention is the only effective treatment to cure the condition.7, 8 Based on the experiences of recent years, it became common practice in our hospital to treat patients with severe recalcitrant HS with a multifactorial approach, as was recently described in the Dutch treatment guidelines for HS.9 The first step is treatment with two antibiotics (clindamycin 300 mg twice daily + rifampicin 300 mg twice daily) for 2–4 months. If patients are not responding to antibiotic treatment, and a clear inflammatory component [purple inflammation around HS lesions, rubor, calor, dolor, fever, increased erythrocyte sedimentation rate (ESR) or C‐reactive protein (CRP)] is present, a TNF‐α inhibitor is added. Subsequently, after an observation period of 3–6 months, remaining sinuses and fistulas not responding to the anti‐inflammatory treatment are removed surgically.