Department of Dermatology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Br J Dermatol. 2013 Feb;168(2):243-52. doi: 10.1111/bjd.12104.
Hidradenitis suppurativa (HS) is a difficult disease to treat. Although the pathogenesis of this inflammatory skin disease is largely unknown, the important role of the immune system has been demonstrated in both experimental and clinical studies. Clinicians are therefore increasingly prescribing systemic treatments with immunosuppressive agents, but the more traditionally used systemic retinoids, especially isotretinoin, also remain relatively common therapies. In order to provide an overview of all currently available systemic immunosuppressive agents and retinoids for the treatment of HS, a systematic search was performed using the Medline and Embase databases. All published papers concerning systemic retinoids or immunosuppressive treatments for HS in adults were included. The primary endpoints were the percentages of significant responders, moderate responders and nonresponders. Other endpoints were the relapse rate and adverse events. In total 87 papers were included, comprising 518 patients with HS who were treated with systemic retinoids, biological agents or another immunosuppressive agents, including colchicine, ciclosporin, dapsone or methotrexate. The highest response rates were observed with infliximab, adalimumab and acitretin. Overall, the quality of evidence was low and differed between the agents, making direct comparisons difficult. However, based on the amount of evidence, infliximab and adalimumab were the most effective agents. Acitretin was also effective in HS, although the quality of the evidence was low. The therapeutic effect of isotretinoin is questionable. Randomized controlled trials are needed to confirm the effectiveness of acitretin, and to identify the most effective immunosuppressive agents in HS.
化脓性汗腺炎（HS）是一种难以治疗的疾病。尽管这种炎症性皮肤病的发病机制在很大程度上尚不清楚，但在实验和临床研究中都表明免疫系统起着重要作用。因此，临床医生越来越多地开具有免疫抑制作用的全身性治疗药物，但传统上使用的全身性维 A 酸类药物，尤其是异维 A 酸，仍然是相对常见的治疗方法。为了全面了解目前可用于治疗 HS 的所有全身性免疫抑制剂和维 A 酸类药物，我们使用 Medline 和 Embase 数据库进行了系统检索。纳入了所有关于成人 HS 的全身性维 A 酸类药物或免疫治疗的已发表论文。主要终点是有显著应答、中度应答和无应答的患者比例。其他终点是复发率和不良事件。共纳入 87 篇论文，其中包括 518 例接受全身性维 A 酸类药物、生物制剂或其他免疫抑制剂（包括秋水仙碱、环孢素、氨苯砜或甲氨蝶呤）治疗的 HS 患者。英夫利昔单抗、阿达木单抗和阿维 A 酸的应答率最高。总体而言，证据质量低且在不同药物之间存在差异，因此难以进行直接比较。但是，基于证据量，英夫利昔单抗和阿达木单抗是最有效的药物。阿维 A 酸在 HS 中也有效，尽管证据质量较低。异维 A 酸的治疗效果值得怀疑。需要进行随机对照试验来证实阿维 A 酸的有效性，并确定 HS 中最有效的免疫抑制剂。
