Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory disease of the skin characterized by recurrent and painful nodules, which can cause sinus tract and scar tissue.1,2 HS generally occurs at puberty, with an average age of 2–3 decades of life and predominance. women.3 HS has a major impact on the patient's quality of life, social and psychological.4
HS epidemiological data show mixed results. In Europe the prevalence is about 1% in the general population5,6 and 4% in the young adult female population.7 In the Americas the prevalence is around 0.05–0.20%.8,9 The burden of disease is increasing due to difficulties in diagnosis, with an average The average delay in diagnosis is up to 7 years.10 The cause and pathogenesis of HS are still not clearly understood, but it is suspected that there is auto-inflammation in the hair follicle area. Environmental factors that play a role include smoking habits and obesity. Some cases show genetic involvement with 100% penetration in various populations as well as familial factors in 30–40% of patients.6,11–15
Follicular occlusion following rupture releases keratin and bacteria into the dermis, triggering a chemotactic response of neutrophils and lymphocytes. Macrophages that migrate to the dermis will release TNF- and IL-1β thereby triggering a cascade of release of other proinflammatory cytokines such as IL-20, IL-22 and IL-23. These cytokines will attract more neutrophils for migration and inflammation. Other factors that may play a role in the pathogenesis of HS are abnormal secretion of apocrine glands, invagination of the epidermis, and decreased number of sebaceous glands. Research has shown an increase in pro-inflammatory cytokines such as TNF-, IL-1β, IL-10 and CRP.16 ,18
The main symptom of HS is a reddish subcutaneous nodule measuring < 1 cm with dermal contractures or elevation. The body parts most commonly affected by HS are the scalp, eyelids, retroauricular, chest, breasts and folds, axillae, pubic, inguinal, buttocks, perineal and perianal areas.19,20 More than 50% of patients complain of a burning or stinging sensation, pain, itching, and hyperhidrosis.6 Because the clinical picture of HS resembles that of other inflammatory skin sequelae such as furunculosis and carbuncle, the diagnosis of HS must be made with care.
To date, there are limitations in the treatment options for HS. Indonesia itself does not yet have a HS management guideline. Topical clindamycin therapy is one of the therapies that has been proven to treat superficial lesions.21,22 For systemic therapy, the combination of clindamycin-rifampin and rifampicin-moxifloxacin-metronidazole has shown mixed results.23–28 The biologic therapy of ADA has shown satisfactory results and is recognized by the Food and Drug Administration. Drug Administration (FDA) for moderate to severe HS in adults who do not respond to antibiotics.29,32–34
Research on drugs for HS is still very limited. Ongoing clinical trials include ADA, secukinumab, apremilast and metformin.30–34 Based on this, it is necessary to review the potential of drugs used for HS so that they can be the basis for making management guidelines with good evidence-based medicine. As ADA is the only HS drug that has gone through various stages of clinical trials, a systematic review of the potential of ADA in treating HS was carried out.