The role of biologic treatment in special scenarios in hidradenitis suppurativa: Facial and nape phenotype, dissecting cellulitis of the scalp, and lymphedema

Abstract

Background:
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder affecting the hair follicle which typically affects the axilla, inguinal, sub-mammary and perianal areas. Atypical HS, such as facial HS, dissecting cellulitis of the scalp (DCS), nape HS and HS lymphedema has also been described. There is scarce evidence about the treatment of atypical HS.

Aims:
To describe the efficacy of biologic drugs and adjuvant therapeutic interventions used in patients with atypical HS who had an inadequate response to systemic antibiotics.

Methods:
Prospective case series study of patients with atypical HS (facial HS, DCS, nape HS and HS lymphedema) treated with biologic drugs in a HS Clinic setting. Disease activity indexes, socio-demographic, clinical and safety variables were collected.

Results:
Two patients met criteria for Facial HS, three met criteria for DCS / nape HS and three patients met criteria for HS lymphedema. Patients with facial HS achieved rapid improvement without requiring other therapies. Patients with DCS, nape HS and HS lymphedema showed variable response, with decrease of activity indexes, and requiring adjuvant treatments.

Conclusions:
Biologic drugs are useful in the management of special HS locations. In the case of facial HS, biologic therapy seems to be quite effective as monotherapy. In the cases of DCS, HS lymphedema and nape HS, treatment combination or intensification may be needed. This article is protected by copyright. All rights reserved.

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SHORT PAPER
The role of biologic treatment in special scenarios in
hidradenitis suppurativa: Facial and nape phenotype, dissecting
cellulitis of the scalp, and lymphedema
Manuel Sanchez-Diaz
1
| Antonio Martinez-Lopez
1,2
| Luis Salvador-Rodriguez
1
|
Trinidad Montero-Vilchez
1
| Salvador Arias-Santiago
1,2
| Alejandro Molina-Leyva
1,2,3
1
Hidradenitis Suppurativa Clinic, Department
of Dermatology, Hospital Universitario Virgen
de las Nieves, Granada, Spain
2
European Hidradenitis Suppurativa
Foundation (EHSF), Dessau-Roßlau, Germany
3
Instituto de Investigación Biosanitaria,
Granada, Spain
Correspondence
Salvador Arias-Santiago, Dermatology
Department, Hospital Universitario Virgen de
las Nieves, Avenida de las Fuerzas Armadas
2, Granada, Spain.
Email: salvadorarias@ugr.es
Abstract
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder affecting the hair
follicle which typically affects the axilla, inguinal, submammary, and perianal areas.
Atypical HS, such as facial HS, dissecting cellulitis of the scalp (DCS), nape HS, and
HS lymphedema has also been described. There is scarce evidence about the treat-
ment of atypical HS. To describe the efficacy of biologic drugs and adjuvant thera-
peutic interventions used in patients with atypical HS who had an inadequate
response to systemic antibiotics. Prospective case series study of patients with atypi-
cal HS (facial HS, DCS, nape HS, and HS lymphedema) treated with biologic drugs in
a HS Clinic setting. Disease activity indexes, sociodemographic, clinical, and safety
variables were collected. Two patients met criteria for Facial HS, three met criteria
for DCS/nape HS and three patients met criteria for HS lymphedema. Patients with
facial HS achieved rapid improvement without requiring other therapies. Patients
with DCS, nape HS, and HS lymphedema showed variable response, with decrease of
activity indexes, and requiring adjuvant treatments. Biologic drugs are useful in the
management of special HS locations. In the case of facial HS, biologic therapy seems
to be quite effective as monotherapy. In the cases of DCS, HS lymphedema and nape
HS, treatment combination or intensification may be needed.
KEYWORDS
hidradenitis suppurativa, inflammatory disorders, pharmacology, therapy-systemic
1|BACKGROUND
Hidradenitis suppurativa (HS) is a chronic inflammatory disorder
affecting the hair follicle whose lesions cause pain, suppuration and
malodor and may significantly impair quality of life.
1
Different classifi-
cations have been proposed based on the phenotypes of the disease.
2
Dissecting cellulitis of the scalp (DCS), facial HS, nape HS, and HS
lymphedema are examples of atypical HS presentations. Its manage-
ment is generally complex, showing variable response to therapies,
with the need for biologic treatments in a high percentage of cases.
3-6
The aim of this study is to identify those patients with atypical HS
who have an inadequate response to first-line antibiotics within a
cohort of patients with HS, and to describe the efficacy of the biologic
therapy and adjuvant therapeutic interventions used.
2|METHODS
A prospective case series study of consecutive patients with atypical
HS treated at the Hidradenitis Suppurativa Unit of the Virgen de las
Nieves University Hospital from December 2016 to March 2020. This
study was approved by the Institutional Review Board of the hospital.
Received: 15 November 2020 Revised: 21 January 2021 Accepted: 23 January 2021
DOI: 10.1111/dth.14829
Dermatologic Therapy. 2021;34:e14829. wileyonlinelibrary.com/journal/dth © 2021 Wiley Periodicals LLC. 1of9
https://doi.org/10.1111/dth.14829