Acta Dermato-Venereologica issue 50:1 98-1CompleteContent | Page 43

151 SHORT COMMUNICATION Successful Treatment of Severe Recalcitrant Hidradenitis Suppurativa with the Interleukin-17A Antibody Secukinumab Anna SCHUCH, Tatjana FISCHER, Alexander BOEHNER, Tilo BIEDERMANN and Thomas VOLZ Department of Dermatology and Allergology, Technical University Munich, Biedersteinerstr. 29, DE-80802 München, Germany. E-mail: [email protected] Accepted Sep 13, 2017; Epub ahead of print Sep 13, 2017 Hidradenitis suppurativa (HS), or acne inversa, is a chronic recurrent inflammatory skin disease mainly af- fecting the axillary, inguinal and anogenital region. The estimated prevalence of HS is 1% (1, 2). HS is charac- terized by deep-seated inflammatory nodules, abscesses and sinus tracts (3). Enhanced expression of tumour necrosis factor (TNF)-α, interleukin (IL)-1β and IL-17 has been reported in HS lesions, and treatment with the anti-TNF antibody adalimumab has been approved for therapy of moderate-to-severe HS (4–6). As response rates to adalimumab range from 40% to 60%, there is an unmet need for further therapeutic options. We report here a case of severe recalcitrant HS treated successfully with the anti-IL-17A antibody secukinumab in a patient refractory to therapy with adalimumab and infliximab. During an 8-week therapy a rapid clinical response was observed, with almost complete disappearance of inflam- matory nodules and continuous reduction in the signs of cutaneous inflammation. CASE REPORT A 24-year-old non-smoking patient who had had HS for 6 years presented with recurrent inflammatory nodules and extensive cutaneous inflammation, mainly affecting the groins and gluteal region (Fig. 1A). Previous therapies, including a combination of clindamycin and rifampicin (each at 300 mg twice a day) or isotretinoin 30 mg per day, or anti-TNF-α treatment with adalimumab or infliximab, had had no effect on the severity and course of HS lesions. Wide excision of the abscesses and sinus tracts in both groins and gluteal regions, with subsequent secondary healing, was performed one year before presentation. At presentation the patient had recurrent HS, with many highly inflammatory nodules and extensively affected groins and gluteal area. At baseline (day 0) the patient had a Hidradenitis Suppurativa Score (HSS, modified Sartorius Score) of 90 (Fig. 2A). The HSS takes into account the number of inflamed nodules and fistulas, the dispersion of lesions and the Hurley stage, and is first cal- culated separately for each affected body area, then sum- med to produce a final score (7). Laboratory findings at baseline (week 0) revealed leukocytosis, with white blood cell count 13.26×10 9 /l (reference range 4.0–9.0×10 9 /l) and C-reactive protein (CRP) 4.3 mg/dl (reference range < 0.5 mg/dl). In addition, serum amyloid A showed a large increase, at 127.0 mg/l (reference range ≤ 6.4 mg/l). Secukinumab was subsequently administered, at a dose of 300 mg weekly for 1 month (days 0, 7, 14, 21 and 28), followed by injections at 4-week intervals. One week after the start of secukinumab treatment a reduction in inflammatory nodules and resolution of the signs of cutaneous inflammation were observed. This therapeutic effect continued over subsequent weeks, resulting in almost complete resolution of inflammatory nodules after 8 weeks (Fig. 1B). A continuous reduction Fig. 1. Rapid clinical response of hidradenitis suppurativa (HS) to secukinumab treatment. Clinical images of the genital and gluteal region (A) before and (B) after 8 weeks of treatment with the interleukin-17A antibody secukinumab, demonstrating rapid reduction in inflammatory nodules and signs of cutaneous inflammation. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2794 Acta Derm Venereol 2018; 98: 151–152