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The Cutting Edge: Challenges in Medical and Surgical Therapies |

Severe Refractory Hidradenitis Suppurativa in an HIV-Positive Patient Successfully Treated With Infliximab

Diana Alecsandru, MD, PhD; Belén Padilla, MD, PhD; José Antonio Avilés Izquierdo, MD; Eduardo Fernández-Cruz, MD, PhD; Silvia Sánchez-Ramón, MD, PhD
Arch Dermatol. 2010;146(12):1343-1345. doi:10.1001/archdermatol.2010.372.
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Hidradenitis suppurativa (HS) is a chronic, suppurative, cicatricial cutaneous disease involving the apocrine gland–bearing follicular epithelium. This disorder is characterized by recurrent skin abscesses, persistent pain, sinus tract fistula formation, and subsequent scarring. The treatment of HS is complex, usually unsatisfactory, and transiently effective, and includes topical or systemic antibiotics (tetracyclines, clindamicin hydrochloride, rifampicin), topical antiseptics and intralesional corticosteroids, systemic retinoids (isotretinoin), and antiandrogen drugs (cyproterone acetate, finasteride). Often, severe HS requires invasive surgical excision of the involved tissue, with cosmetically unacceptable results and without precluded recurrences. Blockers of tumor necrosis factor (TNF) are increasingly used as a novel treatment for several dermatologic diseases. Infliximab (Remicade; Schering-Plough, Whitehouse Station, New York), a monoclonal chimeric anti-TNF antibody, has demonstrated efficacy for severe HS therapy in patients without human immunodeficiency virus (HIV).1 Infliximab was successfully used in the treatment of HIV-associated Reiter syndrome,2 HIV-associated psoriasis and psoriasis arthritis,3 and HIV-associated Crohn disease.4 Available data from the literature suggest that the administration of anti-TNF biologic therapy in HIV-infected patients does not induce higher morbidity and mortality rates in these individuals,5 although the exact role of TNF in HIV/AIDS is not completely understood.24,6 We report the case of a 47-year-old HIV-1–positive patient who was affected by severe, refractory, long-standing HS that responded to infliximab treatment after failure of conventional therapy.

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Figure.

A 47-year-old man with human immunodeficiency virus–1 with severe axillary, gluteal, perianal, thoracic, and abdominal hidradenitis suppurativa (HS). A, Severe gluteal inflammatory and suppurative lesions (HS) before infliximab therapy. B, Gluteal region after 2 years of infliximab therapy.

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