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Hidradenitis suppurativa is a chronic suppurative disease characterized by inflammatory nodules, fistulas and scarring predominantly in the armpits and the groins. Systemic therapy including oral antibiotics, retinoids or antiandrogens has only limited effect, advanced stages require surgical treatment of affected areas. Recently, there were some reports of successful therapy of hidradenitis suppurativa by TNF-α antagonists. In contrast to infliximab and etanercept, the positive effect of adalimumab was described only in small cohorts of patients. Nine patients with severe, recalcitrant hidradenitis were treated for 1 year with adalimumab in a standard regimen and followed-up for 1 year. All patients improved within 4-6 weeks and laboratory parameters like CRP and leucocyte count were reduced significantly during the treatment. In four patients we observed a long lasting improvement, five patients showed recurrences several months after the therapy discontinuation. Average recurrence-free interval was 9 months. According to our experience therapy with adalimumab is suitable for treatment and induction of long-term remission in severe hidradenitis suppurativa. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic disease characterized by recurrent inflammatory nodules, sinus tracts with suppuration, abscesses and scarring in the skin folds containing terminal hair and apocrine glands. Hidradenitis suppurativa usually manifests after puberty, most often in the third decade; and persists into old age. The prevalence of the disease is approximately 1%. Axillary and inguinal involvement is more common in females, perianal and gluteal areas are predominantly affected in males. The exact etiopathology is still unknown. The primary event is hyperkeratosis leading to follicular occlusion with distension and destruction of infundibulum that provokes large inflammatory reaction in the adjacent tissue. Smoking and obesity may be potential triggering factors. Squamous cell carcinoma and arthropathy belong to the main complications of hidradenitis suppurativa. Treatment depends on the stage of the disease. Topical therapy with antibiotics, antiseptics or long-term systemic antibiotic therapy is suitable for initial and mild forms. In advanced stages, systemic retinoids, antiandrogens, steroids or cyclosporin A are used and anti-TNF drugs have shown promising effect in the severe cases, recently. Total wide excision of the affected area remains the only curative procedure. [ABSTRACT FROM AUTHOR]