Emerging treatments

Anakinra

Results from a small double-blind, randomized, placebo-controlled trial suggest that anakinra, an interleukin (IL)-1 receptor antagonist, may prolong time to a new HS exacerbation.[65]

Topical resorcinol

Uncontrolled studies suggest that topical resorcinol 15%, a keratolytic and antiseptic, may benefit patients with mild to moderate HS.[66][67] Adverse effects may include skin irritation, pigment change, and desquamation.[66] Topical resorcinol may need to be compounded by a pharmacy.

Ustekinumab

Ustekinumab, an IL-12/23 inhibitor, was found to be moderately effective (response rate approximately 50%) in an open-label study of patients with HS.[68] A subsequent literature review reported that, in most cases, HS begins to improve 3 to 5 months after initiation of ustekinumab.[69]

Secukinumab

A human monoclonal antibody that inhibits IL-17A. A systematic review of available treatment outcomes suggests that 57.1% (n=60/105) of HS patients treated with secukinumab were responders (mean response period of 16 weeks).[70] Phase 3 studies are recruiting or ongoing.[71]

Finasteride

North American guidelines suggest that hormonal agents, including finasteride, may be considered in women with clear premenstrual flares (while recognizing that recommendations regarding hormonal therapies are based on limited evidence).[43] A retrospective chart review found that androgen blockade therapy with finasteride is safe and effective among female patients with HS with a contraindication or intolerance to spironolactone.[72]

Laser or light-based therapy

One Cochrane review reported on three small randomized controlled trials (RCTs) of laser or light treatment for HS, concluding that their low quality made it difficult to make treatment recommendations.[73] A subsequent systematic review concluded that there is a need for large RCTs.[74]

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