Clinical response rate and flares of hidradenitis suppurativa in the treatment with adalimumab.

BACKGROUND: Hidradenitis suppurativa/acne inversa (HS) is a chronic, inflammatory, skin disease. adalimumab is the sole approved drug for the treatment of HS, but it only partially controls the symptoms. AIM: To evaluate the incidence of flares during 108 weeks of therapy and the clinical response to adalimumab. METHODS: In total, 20 patients with moderate-severe HS treated with adalimumab were included to evaluate the number of flares, mean time interval between flares, lesion count number of patients who reached the Hidradenitis Suppurativa Clinical Response (HiSCR) of ≥ 50% reduction in inflammatory lesion count, and the International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (VAS) and Dermatology Life Quality Index (DLQI). RESULTS: In total, 90% of patients reported at least 1 flare, and in total 48 flares were counted for the whole group; mean time between flares was 26.9 ± 16.4 weeks. Duration between flares was 30.5 ± 16.3 and 12.5 ± 5.7, respectively, in responders and nonresponders. A progressive decline in flares was observed with treatment, while a gradual increase in the number of patients achieving HiSCR was attained during the observational period. Lesion count, IHS4, pain VAS and DLQI decreased throughout the study. In detail, adalimumab showed a higher efficacy on nodules and abscesses than on draining tunnels. The study was limited by its retrospective nature and small number of patients. CONCLUSION: Adalimumab is an effective and safe treatment for patients with HS despite the high number of flares.

New insights into the pathogenesis of cutaneous autoimmune disorders.

T helper 17 (Th17) cells are characterized by the secretion of IL-17, a proinflammatory cytokine. They represent a newly described T helper subpopulation that is distinct from Th1 and Th2 lineages. Because of their pleiotropic activity on fibroblasts, keratinocytes, endothelial cells, neutrophils and memory T cells, Th17 cells are thought to be crucial in mediating tissue inflammation and autoimmunity. Autoimmune diseases were classically considered as Th1-mediated disorders such as rheumatoid arthritis or mixed Th1/Th2 diseases such as inflammatory bowel diseases, systemic lupus erythematosus, bullous diseases, but new evidence suggests the deep involvement of Th17 cells in their pathogenesis that, potentially, may address a selective therapeutic approach targeting the IL23/Th17 pathway. This review summarizes the current knowledge of the pathogenic contribution of Th17 cells in select cutaneous autoimmune disorders, including lupus erythematosus, scleroderma, dermatomyositis, bullous pemphigoid and pemphigus vulgaris.