Robert E, Bodin F, Paul C, Konstantinou M-P, Gall Y, Grolleau J-L, Laloze J, Chaput B
Department of plastic surgery, Strasbourg university hospitals, university of Strasbourg, 67091 Strasbourg, France.
Department of dermatology, Rangueil-Larrey hospital, Paul-Sabatier university, 31059 Toulouse, France.
Ann Chir Plast Esthet. 2017 Aug;62(4):274-294. doi: 10.1016/j.anplas.2017.03.012. Epub 2017 Apr 28.
The management of hidradenitis suppurativa is multidisciplinary, involving general measures, medical treatment and surgery. Non-surgical treatments, often first-line procedures, mainly concern forms of low-to-moderate severity or, conversely, very severe forms in non-operable patients or those refusing surgery. While many treatments have been attempted, few randomized controlled trials have been conducted, so the choice of treatments is most often based on the personal experience of the clinicians. The objective of this systematic review is to propose a synthetic analysis of the currently available non-surgical procedures.
This systematic review of the literature was conducted in accordance with the PRISMA criteria. We searched for articles in the Medline, PubMed Central, Embase and Cochrane databases published between January 2005 and September 2015.
Sixty-four articles were included. They generally had a low level of evidence; indeed, the majority of them were retrospective observational studies. They involved biotherapy (44%), dynamic phototherapy (16%), antibiotics (11%), Laser (8%), retinoids (6%) and immunosuppressive therapies, anti-inflammatory drugs, zinc, metformin, gammaglobulins and fumarates.
None of the non-surgical treatments can treat all stages of the disease and offer long-term remission. Antibiotics and biotherapy seem to have real effectiveness but their effect remains suspensive and the disease is almost certain to reappear once they are stopped. As regards antibiotics, no association has shown their superiority in a study with a high level of evidence. And while some biotherapies seem quite effective, due to their side effects they should be reserved for moderate-to-severe, resistant or inoperable forms of the disease. Randomized controlled studies are needed before valid conclusions can be drawn. In the resistant or disabling forms, it is consequently advisable to orientate to the greatest possible extent towards radical surgery, which is the only treatment allowing hope for cure.
化脓性汗腺炎的治疗是多学科的，包括一般措施、药物治疗和手术治疗。非手术治疗通常是一线治疗方法，主要针对轻至中度病情的患者，或者相反，适用于无法进行手术或拒绝手术的非常严重病情的患者。虽然已经尝试了许多治疗方法，但很少有随机对照试验，因此治疗方法的选择通常基于临床医生的个人经验。本系统评价的目的是对目前可用的非手术治疗方法进行综合分析。
本系统文献评价按照PRISMA标准进行。我们在Medline、PubMed Central、Embase和Cochrane数据库中检索了2005年1月至2015年9月发表的文章。
纳入了64篇文章。这些文章的证据水平普遍较低；实际上，其中大多数是回顾性观察研究。它们涉及生物疗法（44%）、动态光疗（16%）、抗生素（11%）、激光（8%）、维甲酸（6%）以及免疫抑制疗法、抗炎药物、锌、二甲双胍、丙种球蛋白和富马酸盐。
没有一种非手术治疗方法能够治疗疾病的所有阶段并实现长期缓解。抗生素和生物疗法似乎具有实际疗效，但它们的效果仍然是暂时的，一旦停药疾病几乎肯定会复发。关于抗生素，在一项高证据水平的研究中没有显示出它们的优越性。虽然一些生物疗法似乎相当有效，但由于其副作用，应仅用于中度至重度、耐药或无法手术的疾病形式。在得出有效结论之前需要进行随机对照研究。因此，对于耐药或致残形式的疾病，建议尽可能转向根治性手术，这是唯一有望治愈的治疗方法。
