Systemic Therapy With Immunosuppressive Agents and Retinoids in Hidradenitis Suppurativa

A Systematic Review

J.L. Blok; S. van Hattem; M.F. Jonkman; B. Horváth


The British Journal of Dermatology. 2013;168(2):243-252. 

In This Article

Patients and Methods

Inclusion and Exclusion Criteria

Included in the study were all fully published papers that reported on the clinical effects of any systemic immunosuppressive agents or systemic retinoids in HS localized at the typical inverse regions. Patients had to be aged 18 years or older. Studies not exclusively dealing with HS were excluded, unless data for HS could be extracted separately. Studies were excluded if insufficient details were given on the treatment regimen in respect of dosing, treatment duration and concomitant immunosuppressive medication. There were no language restrictions.

Types of Outcome Measures

The efficacy of treatment was classified for each patient as 'significant response', 'moderate response' or 'nonresponse'. A significant response was defined as a reduction of the Sartorius score of ≥ 50%, improvement in quality of life of > 50%, or if stated so by the authors. A moderate response comprised score reductions < 50%, or if stated so by the authors. The primary endpoints comprised the percentages of significant responders, moderate responders and nonresponders. If a study did not report individual results, all patients from that study were categorized corresponding to the reported mean results. Dropouts were considered to be nonresponders. The secondary endpoint was the percentage of responders who relapsed during or after discontinuation of treatment, and the tertiary endpoint comprised adverse events (AEs).

Identification of Studies

Databases were systematically searched by two independent authors (S.vH. and J.L.B.) for studies dated up to May 2012. A search was conducted using Embase [search terms: 'hidradenitis suppurativa'/exp OR 'hidradenitis suppurativa' OR (hidraden* AND suppurativ*) OR 'acne inversa' OR 'inverse acne'] and Medline [search terms: 'hidradenitis suppurativa'(MeSH) OR (hidraden* AND suppurativ*) OR 'acne inversa' OR 'inverse acne']. Reference lists of included papers and relevant reviews were manually searched to identify additional papers.

Data Extraction and Analysis

Two authors (J.L.B. and S.vH.) independently conducted data extraction using standardized forms. Discrepancies between the researchers were resolved through discussion. Authors were not contacted for missing data.

Data were analysed by means of descriptive statistics.

Quality Assessment

The quality of evidence was assessed by grading as follows: A, systematic review or meta-analysis, randomized controlled trial with consistent findings, or all-or-none observational study; B, lower-quality clinical trial or study with limitations and inconsistent findings, cohort study or case–control study; or C, consensus guidelines, usual practice, expert opinion or case series.[17]