Nonsurgical Tx May Aid Hidradenitis Suppurativa


HOUSTON — Intralesional steroid injections or systemic therapy with tumor necrosis factor-α inhibitors are two nonsurgical treatments that are well worth considering for hidradenitis suppurativa, Dr. Peter J. Lynch said at a conference on vulvovaginal diseases jointly sponsored by Baylor College of Medicine and the Methodist Hospital.

“Intralesional steroid injections are perfect if the woman has only two or three lesions and they only become active every couple of weeks,” he said in an interview. “It's easier and less painful than incising, but reactivation is almost certain to occur. It's almost like first aid—not a definitive approach.”

Dr. Lynch recommended using triamcinolone acetonide at a dose of 10 mg/cc for this treatment.

“With a 27- or 30-gauge needle, you can place one- or two-tenths of a cc into a fingertip- or thumb-sized nodule and that will really quiet it down for a couple of weeks at least, maybe a month or two,” said Dr. Lynch, professor and chair of the dermatology department at the University of California, Davis.

Dr. Lynch said systemic therapy with tumor necrosis factor-α (TNF-α) inhibitors is the second nonsurgical treatment about which he recently has become excited. “TNF-α inhibitors seem to be particularly effective for granulomatous type infections and, of course, that's exactly what's happening in hidradenitis suppurativa,” he said.

Although use of these drugs for hidradenitis is considered off label, the therapy's safety record now is good for treating Crohn's disease, rheumatoid arthritis, psoriasis, and psoriatic arthritis, he said. However, he warned insurance coverage is difficult to get, and the cost is prohibitive at $10,000–$15,000 a year.

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