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Accepted: 8 December 2021 / Published online: 6 January 2022
© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022
Abstract
Hidradenitis suppurativa (HS) is a severe chronic relapsing inflammatory disorder of the hair follicle unit that can cause painful abscesses, nodules, tunnels, and tracts in intertriginous parts of the body. The disease can often result in disfigurement and adversely impact patient quality of life. The management of HS has expanded significantly over the past decade to include multiple modalities, including topical therapies, systemic therapies (non-biologics and biologics), surgical therapies, lifestyle changes, and management of comorbidities. Management can often be clinically challenging and may involve the combination of medical and surgical approaches for optimal results. The purpose of this review is to present an update on non-biologic and non-interventional modalities published in 2019-2021 in the clinical management of HS. With emerging therapies, ongoing clinical trials, and heightened awareness about HS, there is hope that new treatment options will revolutionize the management of patients suffering from HS.
1Introduction
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder involving intertriginous areas. Inflammation in patients with HS is not restricted to the skin but is systemic, affecting several other organs [1]. Patients with HS are not only affected by recurrent painful draining skin lesions but also with associated comorbidities, including, but not limited to, metabolic syndrome and mood disorders [2, 3]. The earlier implementation of proper treatment is associated with better outcomes. Not uncommonly, patients with HS are faced with late diagnosis and undertreatment, and in dermatology we face patients suffering from both inflammation and fibrosis. The management of HS requires multiple modalities and a team approach to include the management of inflammation (amenable to medical treatment), scarring (amenable to surgery). and comorbidities (to involve a multidisciplinary approach). Biologics remain the treatment of choice for moderate to severe disease and surgical intervention is the treatment of choice for addressing permanently damaged tissue. There remains an adjunctive role for non-biologic therapies to be used in conjunction with biologics and surgical interventions in moderate to severe disease or as monotherapy for mild disease. Even though approval of the first anti-tumor necrosis factor (TNF) inhibitor in the management of HS shed light on this disease, with many more targeted...