SYSTEMATIC REVIEW OF PHARMACOTHERAPY STRATEGIES IN THE MANAGEMENT OF HIDRADENITIS SUPPURATIVA
Abstract
Introduction: Hidradenitis suppurativa (HS, acne inversa) is a chronic, recurrent inflammatory dermatosis with an etiopathogenesis that remains not fully understood. Characteristic skin lesions—nodules, abscesses, sinus tracts, and scars—are most commonly located in skin fold areas, leading to a significant deterioration in patients’ quality of life, both physically and psychosocially. Despite advances in medical knowledge, the diagnosis of HS is often delayed, and treatment represents a major clinical challenge requiring individualized therapeutic approaches. This article provides a review of current literature on pharmacological treatment strategies for HS, including both topical and systemic therapies. Particular emphasis is placed on antibiotic therapy (e.g., tetracyclines, combination therapy with clindamycin and rifampicin, triple-drug regimens, ertapenem), as well as hormonal and immunomodulatory treatments. Furthermore, the growing role of biologic therapies, including TNF-α and interleukin inhibitors, and the use of emerging targeted agents under investigation are discussed. Attention is also drawn to the importance of androgen receptors and their potential role in the pathogenesis of HS, as reflected in the effectiveness of antiandrogen therapies (e.g., spironolactone or oral contraceptives containing a progestogenic component). The review includes data on the efficacy, safety, and limitations of various therapeutic methods based on clinical trials and systematic reviews. The need for further research on the skin microbiome and immune response mechanisms is highlighted, as it may serve as a basis for the development of new, more targeted therapeutic interventions. It is emphasized that HS treatment should be multidimensional and tailored to disease severity as well as coexisting metabolic and endocrine disorders.
Materials and Methods: The article was written based on scientific papers available on PubMed and Google Scholar
Key findings: Analysis of current evidence indicates that pharmacotherapy constitutes a fundamental component in the management of hidradenitis suppurativa (HS), with treatment outcomes strongly dependent on disease severity. Biological therapies, including adalimumab, secukinumab, and belimumab, have demonstrated significant clinical efficacy in moderate to severe HS, particularly in individuals unresponsive to conventional therapies, and represent a major advancement in disease management. Antibiotics remain widely used, providing symptomatic relief despite HS being a chronic inflammatory rather than an infectious condition. Topical clindamycin (1%) is effective in mild cases with superficial inflammatory lesions but shows limited efficacy in deep nodules and carries a risk of microbial resistance. Systemic antibiotic therapy, especially clindamycin combined with rifampicin, has achieved clinical remission in a substantial proportion of moderate HS cases, whereas severe disease may require intensified regimens, including metronidazole, rifampicin, moxifloxacin, or intravenous ertapenem; however, relapse rates following treatment discontinuation remain high. Anti-androgen therapies, such as spironolactone, finasteride, cyproterone acetate (CPA), and metformin, have demonstrated beneficial effects in women with hormonally driven flares or hyperandrogenic comorbidities. Novel topical and systemic anti-androgen agents (finasteride, flutamide, clascoterone, leuprolide) are currently under investigation, but high-quality randomized controlled trials are
Conclusions: Hidradenitis suppurativa remains a significant therapeutic challenge, with current pharmacological strategies providing only partial and often temporary disease control. Biologic agents offer substantial clinical improvement in refractory moderate to severe HS, whereas antibiotics and anti-androgen therapies remain valuable options in mild to moderate disease, albeit with limitations such as high relapse rates and potential adverse effects, including antimicrobial resistance. The complex and incompletely understood pathophysiology of HS highlights the urgent need for further research into immunologic, microbial, and hormonal pathways to facilitate the development of targeted and personalized treatment approaches.
References
Saunte, D. M. L., & Jemec, G. B. E. (2017). Hidradenitis suppurativa: Advances in diagnosis and treatment. JAMA, 318(20), 2019. https://doi.org/10.1001/jama.2017.16691
Ring, H. C., Theut Riis, P., Zarchi, K., Miller, I. M., Saunte, D. M., & Jemec, G. B. (2017). Prodromal symptoms in hidradenitis suppurativa. Clinical and Experimental Dermatology, 42(3), 261–265. https://doi.org/10.1111/ced.13025
Shams, R. B., & Sayed, C. J. (2024). Patient-reported exacerbating factors for hidradenitis suppurativa: A cross-sectional study. Journal of the American Academy of Dermatology, 91(2), 333–336. https://doi.org/10.1016/j.jaad.2024.03.032
Harvey, L. M., & Fortson, J. K. (2021). Hidradenitis suppurativa at an uncommon site: A review of its clinical features, diagnostic difficulties, and management. Cureus, 13(10), e18704. https://doi.org/10.7759/cureus.18704
Frew, J. W., Lowes, M. A., Goldfarb, N., Butt, M., Piguet, V., O’Brien, E., Ingram, J. R., Jemec, G. B. E., Tan, J., Zouboulis, C. C., Alavi, A., & Kirby, J. S. (2021). Global harmonization of morphological definitions in hidradenitis suppurativa for a proposed glossary. JAMA Dermatology, 157(4), 449–455. https://doi.org/10.1001/jamadermatol.2020.5467
Miller, A., Shahzeidi, P., & Bernhardt, M. (2024). An update on current clinical management and emerging treatments in hidradenitis suppurativa. Skin Therapy Letter, 29(2), 1–6.
Ramirez-GarciaLuna, J. L., Wang, S. C., Yangzom, T., Piguet, V., Kirby, J. S., & Alavi, A. (2022). Use of thermal imaging and a dedicated wound-imaging smartphone app as an adjunct to staging hidradenitis suppurativa. British Journal of Dermatology, 186(4), 723–726. https://doi.org/10.1111/bjd.20884
Li, Q., Patrick, M. T., Sreeskandarajan, S., Kang, J., Kahlenberg, J. M., Gudjonsson, J. E., He, Z., & Tsoi, L. C. (2024). Large-scale epidemiological analysis of common skin diseases to identify shared and unique comorbidities and demographic factors. Frontiers in Immunology, 14, 1309549. https://doi.org/10.3389/fimmu.2023.1309549
Jfri, A., Nassim, D., O’Brien, E., Gulliver, W., Nikolakis, G., & Zouboulis, C. C. (2021). Prevalence of hidradenitis suppurativa: A systematic review and meta-regression analysis. JAMA Dermatology, 157(8), 924–931. https://doi.org/10.1001/jamadermatol.2021.1677
Sinikumpu, S.-P., Jokelainen, J., & Huilaja, L. (2024). Prevalence and characteristics of hidradenitis suppurativa in the Northern Finland Birth Cohort 1986 study: A cross-sectional study of 2, 775 subjects. Acta Dermato-Venereologica, 104, adv14732. https://doi.org/10.2340/actadv.v104.14732
Miller, I. M., McAndrew, R. J., & Hamzavi, I. (2016). Prevalence, risk factors, and comorbidities of hidradenitis suppurativa. Dermatologic Clinics, 34(1), 7–16. https://doi.org/10.1016/j.det.2015.08.002
Greif, C., Gibson, R. S., Kimball, A. B., Holcomb, Z. E., & Porter, M. L. (2024). Evaluating minority representation across health care settings in hidradenitis suppurativa and psoriasis. International Journal of Women’s Dermatology, 10(1), e129. https://doi.org/10.1097/JW9.0000000000000129
Nalla, S. D., Kurakula, S., & Nallur Siddaraju, M. (2023). A rare case of pregnancy after surgical treatment for stage III hidradenitis suppurativa. Cureus, 15(9), 45370. https://doi.org/10.7759/cureus.45370
Ingram, J. R., Woo, P. N., Chua, S. L., Ormerod, A. D., Desai, N., Kai, A. C., Hood, K., Burton, T., Kerdel, F., Garner, S. E., & Piguet, V. (2016). Interventions for hidradenitis suppurativa: a Cochrane systematic review incorporating GRADE assessment of evidence quality. British Journal of Dermatology, 174(5), 970–978. https://doi.org/10.1111/bjd.14418
Dauden, E., Lazaro, P., Aguilar, M. D., Blasco, A. J., Suarez, C., Marin, I., Queiro, R., & Bassas-Vila, J. (2018). Recommendations for the management of comorbidity in hidradenitis suppurativa. Journal of the European Academy of Dermatology and Venereology, 32(1), 129–144. https://doi.org/10.1111/jdv.14517
Khattar, G., Bou Sanayeh, E., Makram, M., Rabah, H., Abu Baker, S., Khan, S., & Hong, C. (2024). The concomitant occurrence of hidradenitis suppurativa and Fournier’s gangrene. European Journal of Case Reports in Internal Medicine, 11(6), 004493. https://doi.org/10.12890/2024_004493
Zhou, P., Jiang, X., & Wang, D. (2024). Hidradenitis suppurativa and cardiovascular diseases: A bidirectional Mendelian randomization study. Skin Research and Technology, 30(7), e13853. https://doi.org/10.1111/srt.13853
Nguyen, T. V., Damiani, G., Orenstein, L. A. V., Hamzavi, I., & Jemec, G. B. (2021). Hidradenitis suppurativa: An update on epidemiology, phenotypes, diagnosis, pathogenesis, comorbidities and quality of life. Journal of the European Academy of Dermatology and Venereology, 35(1), 50–61. https://doi.org/10.1111/jdv.16677
Ballard, K., Sathe, N. C., & Shuman, V. L. (2025). Hidradenitis suppurativa. In StatPearls. StatPearls Publishing.
Chiang, N., & Alhusayen, R. (2025). Hidradenitis suppurativa: A review of the biologic and small molecule immunomodulatory treatments. Journal of Cutaneous Medicine and Surgery, 29(1), NP1–NP20 https://doi.org/10.1177/12034754241300292
Melchor, J., Prajapati, S., Pichardo, R. O., & Feldman, S. R. (2024). Cytokine-mediated molecular pathophysiology of hidradenitis suppurativa: A narrative review. Skin Appendage Disorders, 10(3), 172–179. https://doi.org/10.1159/000536268
Charrow, A., Santiago-Soltero, K., & Porter, M. (2024). Biologics in hidradenitis suppurativa: Progress and new directions. Journal of the American Academy of Dermatology, 91(6S), S27–S30. https://doi.org/10.1016/j.jaad.2024.09.027
Maronese, C. A., Moltrasio, C., Genovese, G., & Marzano, A. V. (2024). Biologics for hidradenitis suppurativa: Evolution of the treatment paradigm. Expert Review of Clinical Immunology, 20(5), 525–545. https://doi.org/10.1080/1744666X.2023.2298356
Lipa, K., Zając, N., Witkowski, G., Ciechanowicz, P., Wiszniewski, K., Szymańska, E., & Walecka, I. (2023). Hidradenitis suppurativa – biologic therapy and other available treatment options. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 40(4), 518–528. https://doi.org/10.5114/ada.2021.112075
Gao, J. L., Otto, T. S., Porter, M. L., & Kimball, A. B. (2024). Hidradenitis suppurativa: New targets and emerging treatments. American Journal of Clinical Dermatology, 25(5), 765–778. https://doi.org/10.1007/s40257-024-00880-1
Daoud, M., Suppa, M., Benhadou, F., Daxhelet, M., Njimi, H., White, J., Jemec, G., & Del Marmol, V. (2023). Overview and comparison of the clinical scores in hidradenitis suppurativa: A real-life clinical data. Frontiers in Medicine, 10, 1145152. https://doi.org/10.3389/fmed.2023.1145152
Sabat, R., Alavi, A., Wolk, K., Wortsman, X., McGrath, B., Garg, A., & Szepietowski, J. C. (2025). Hidradenitis suppurativa. Lancet, 405(10476), 420–438. https://doi.org/10.1016/S0140-6736(24)02475-9
Fardos, M., Ismaili, A., & Moon, S. (2025). Bimekizumab for hidradenitis suppurativa: Pathophysiology and promising interventions. Cutis, 115(1), 22–25. https://doi.org/10.12788/cutis.1154
Zouboulis, C. C., Bechara, F. G., Benhadou, F., Bettoli, V., Bukvić Mokos, Z., Del Marmol, V., Dolenc-Voljč, M., Giamarellos-Bourboulis, E. J., Grimstad, Ø., Guillem, P., Horváth, B., Hunger, R. E., Ingram, J. R., Ioannidis, D., Just, E., Kemény, L., Kirby, B., Liakou, A. I., McGrath, B. M., Marzano, A. V., Matusiak, Ł., Molina-Leyva, A., Nassif, A., Podda, M., Prens, E. P., Prignano, F., Raynal, H., Romanelli, M., Saunte, D. M. L., Szegedi, A., Szepietowski, J. C., Tzellos, T., Valiukevičienė, S., van der Zee, H. H., van Straalen, K. R., Villumsen, B., & Jemec, G. B. E. (2025). European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment. Journal of the European Academy of Dermatology and Venereology, 39(5), 899–941. https://doi.org/10.1111/jdv.20472
Zouboulis, C. C., Tzellos, T., Kyrgidis, A., Jemec, G. B. E., Bechara, F. G., Giamarellos-Bourboulis, E. J., Ingram, J. R., Kanni, T., Karagiannidis, I., Martorell, A., Matusiak, Ł., Pinter, A., Prens, E. P., Presser, D., Schneider-Burrus, S., von Stebut, E., Szepietowski, J. C., van der Zee, H. H., Wilden, S. M., & Sabat, R. (2017). Development and validation of the International Hidradenitis Suppurativa Severity Score System (IHS4), a novel dynamic scoring system to assess HS severity. British Journal of Dermatology, 177(5), 1401–1409. https://doi.org/10.1111/bjd.15748
Dagenet, C. B., De, D. R., Shih, T., Brooks, B., Fixsen, D., Park, S. E., Tran, K. A., Hsiao, J. L., & Shi, V. Y. (2024). Hurley staging training for hidradenitis suppurativa patients. Skin Appendage Disorders, 10(6), 524–527. https://doi.org/10.1159/000539746
Calabrese, L., Malvaso, D., Coscarella, G., Antonelli, F., D’Amore, A., Gori, N., Rubegni, P., Peris, K., & Chiricozzi, A. (2024). Therapeutic potential of IL-1 antagonism in hidradenitis suppurativa. Biomolecules, 14(2), 175. https://doi.org/10.3390/biom14020175
Marques, E., Arenberger, P., Smetanová, A., Gkalpakiotis, S., Zimová, D., & Arenbergerová, M. (2021). Successful treatment of recalcitrant hidradenitis suppurativa with risankizumab after failure of anti-tumour necrosis factor alpha. British Journal of Dermatology, 184(5), 966–967. https://doi.org/10.1111/bjd.19716
Kirchner, S., Yesil, H., & Jaleel, T. (2025). Hidradenitis suppurativa management with antibiotics and systemic therapies. Dermatologic Clinics, 43(2), 221–229. https://doi.org/10.1016/j.det.2024.12.007
Molinelli, E., Brisigotti, V., Simonetti, O., Sapigni, C., D’Agostino, G. M., Rizzetto, G., Giacchetti, A., & Offidani, A. (2022). Efficacy and safety of topical resorcinol 15% versus topical clindamycin 1% in the management of mild-to-moderate hidradenitis suppurativa: A retrospective study. Dermatologic Therapy, 35(6), e15439. https://doi.org/10.1111/dth.15439
Aarts, P., Reeves, J. L., Ardon, C. B., van der Zee, H. H., & Prens, E. P. (2023). Clindamycin-benzoyl peroxide gel compared with clindamycin lotion for hidradenitis suppurativa: A randomized controlled assessor-blinded intra-patient pilot study. Dermatology, 239(4), 670–674. https://doi.org/10.1159/000530758
Buimer, M. G., Ankersmit, M. F. P., Wobbes, T., & Klinkenbijl, J. H. G. (2008). Surgical treatment of hidradenitis suppurativa with gentamicin sulfate: A prospective randomized study. Dermatologic Surgery, 34(2), 224–227. https://doi.org/10.1111/j.1524-4725.2007.34041.x
Jemec, G. B., & Wendelboe, P. (1998). Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. Journal of the American Academy of Dermatology, 39(6), 971–974. https://doi.org/10.1016/S0190-9622(98)70272-5
Fischer, A. H., Haskin, A., & Okoye, G. A. (2017). Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa. Journal of the American Academy of Dermatology, 76(2), 309–313.e2. https://doi.org/10.1016/j.jaad.2016.08.001
Matusiak, Ł., Bieniek, A., & Szepietowski, J. C. (2014). Bacteriology of hidradenitis suppurativa – which antibiotics are the treatment of choice? Acta Dermato-Venereologica, 94(6), 699–702. https://doi.org/10.2340/00015555-1841
Jørgensen, A.-H. R., Yao, Y., Thomsen, S. F., & Ring, H. C. (2021). Treatment of hidradenitis suppurativa with tetracycline, doxycycline, or lymecycline: A prospective study. International Journal of Dermatology, 60(7), 785–791. https://doi.org/10.1111/ijd.15459
Vural, S., Gündoğdu, M., Akay, B. N., Boyvat, A., Erdem, C., & Koçyiğit, P. (2019). Hidradenitis suppurativa: Clinical characteristics and determinants of treatment efficacy. Dermatologic Therapy, 32(5), e13003. https://doi.org/10.1111/dth.13003
Kimball, A. B., Okun, M. M., Williams, D. A., Gottlieb, A. B., Papp, K. A., Zouboulis, C. C., Armstrong, A. W., Kerdel, F., Gold, M. H., Forman, S. B., Korman, N. J., Giamarellos-Bourboulis, E. J., Crowley, J. J., Lynde, C., Reguiai, Z., Prens, E.-P., Alwawi, E., Mostafa, N. M., Pinsky, B., Sundaram, M., Gu, Y., Carlson, D. M., & Jemec, G. B. E. (2016). Two phase 3 trials of adalimumab for hidradenitis suppurativa. New England Journal of Medicine, 375(5), 422–434. https://doi.org/10.1056/NEJMoa1504370
Ingram, J. R., Bates, J., Cannings-John, R., Collier, F., Evans, J., Gibbons, A., Harris, C., Howells, L., Hood, K., Howes, R., Leighton, P., Riaz, M., Rodrigues, J., Stanton, H., Thomas, K. S., & Thomas-Jones, E. (2024). Treatment of Hidradenitis Suppurativa Evaluation Study (THESEUS): A prospective cohort study. British Journal of Dermatology, 190(3), 382–391. https://doi.org/10.1093/bjd/ljad388
Alikhan, A., Sayed, C., Alavi, A., Alhusayen, R., Brassard, A., Burkhart, C., Crowell, K., Eisen, D. B., Gottlieb, A. B., Hamzavi, I., Hazen, P. G., Jaleel, T., Kimball, A. B., Kirby, J., Lowes, M. A., Micheletti, R., Miller, A., Naik, H. B., Orgill, D., & Poulin, Y. (2019). North American clinical management guidelines for hidradenitis suppurativa: Part I: Diagnosis, evaluation, and the use of complementary and procedural management. Journal of the American Academy of Dermatology, 81(1), 76–90. https://doi.org/10.1016/j.jaad.2019.02.067
Caro, C., Molinelli, R. D., & Brisigotti, E. (2021). Lymecycline vs. clindamycin plus rifampicin in hidradenitis suppurativa treatment: Clinical and ultrasonography evaluation. Clinical and Experimental Dermatology, 46(1), 96–102.
Mendonça, C. O., & Griffiths, C. E. M. (2006). Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. British Journal of Dermatology, 154(5), 977–978. https://doi.org/10.1111/j.1365-2133.2006.07155.x
Dessinioti, C., Zisimou, C., Tzanetakou, V., Stratigos, A., & Antoniou, C. (2016). Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: A prospective study and 1-year follow-up. Clinical and Experimental Dermatology, 41(8), 852–857. https://doi.org/10.1111/ced.12933
van der Zee, H. H., Boer, J., Prens, E. P., & Jemec, G. B. (2009). The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa. Dermatology, 219(2), 143–147. https://doi.org/10.1159/000228337
Gener, G., Canoui-Poitrine, F., Revuz, J. E., Faye, O., Poli, F., Gabison, G., & Auquier, A. (2009). Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: A series of 116 consecutive patients. Dermatology, 219(2), 148–154. https://doi.org/10.1159/000228334
Albrecht, J., Baine, P. A., Ladizinski, B., Jemec, G. B., & Bigby, M. (2019). Long-term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. British Journal of Dermatology, 180(4), 749–755. https://doi.org/10.1111/bjd.17265
Aarts, P., van Huijstee, J. C., van der Zee, H. H., van Straalen, K. R., & Prens, E. P. (2024). Improved clinical effectiveness of adalimumab when initiated with clindamycin and rifampicin in hidradenitis suppurativa. Journal of the European Academy of Dermatology and Venereology, 38(5), 904–909. https://doi.org/10.1111/jdv.19725
Delage, M., Jais, J.-P., Lam, T., Guet-Revillet, H., Ungeheuer, M.-N., Consigny, P.-H., & Revuz, J.-E. (2023). Rifampin–moxifloxacin–metronidazole combination therapy for severe Hurley stage 1 hidradenitis suppurativa: Prospective short-term trial and 1-year follow-up in 28 consecutive patients. Journal of the American Academy of Dermatology, 88(1), 94–100. https://doi.org/10.1016/j.jaad.2020.01.007
Ring, H. C., Knudsen, A., & Thomsen, S. F. (2021). Metronidazole for hidradenitis suppurativa: Future potential treatment applications. Journal of the European Academy of Dermatology and Venereology, 35(5), e323–e324. https://doi.org/10.1111/jdv.17069
Join-Lambert, O., Coignard-Biehler, H., Jais, J.-P., Delage, M., Guet-Revillet, H., Poirée, S., & Toussaint, F. (2016). Efficacy of ertapenem in severe hidradenitis suppurativa: A pilot study in a cohort of 30 consecutive patients. Journal of Antimicrobial Chemotherapy, 71(2), 513–520. https://doi.org/10.1093/jac/dkv361
Braunberger, T. L., Nartker, N. T., Nicholson, C. L., Nahhas, A. F., Parks-Miller, A., Hanna, Z., & Abrahams, C. (2018). Ertapenem – a potent treatment for clinical and quality of life improvement in patients with hidradenitis suppurativa. International Journal of Dermatology, 57(9), 1088–1093. https://doi.org/10.1111/ijd.14036
Ramesh, M., Jayaprakash, R., Hanna, Z., Gunasekaran, K., Stein, T., & Abreu-Lanfranco, O. (2017). More than just an anti-infective agent: A prospective pilot clinical trial to determine the effectiveness of IV ertapenem in severe hidradenitis suppurativa. Open Forum Infectious Diseases, 4(suppl_1), S110. https://doi.org/10.1093/ofid/ofx163.115
Segura Palacios, J. M., Soto Moreno, A., Valladares Millán, I., Rivas Ruiz, F., Cuenca Barrales, C., & Molina Leyva, A. (2023). Intramuscular ertapenem for the treatment of severe cases of hidradenitis suppurativa. Journal of Dermatological Treatment, 34(1), 2179368. https://doi.org/10.1080/09546634.2023.2179368
Masson, R., Seivright, J., Shih, T., Bennett, R. G., Hogeling, M., & Shi, V. Y. (2023). Trimethoprim/sulfamethoxazole and cephalexin combination therapy in hidradenitis suppurativa patients: A series of 16 cases. JAAD Case Reports, 37, 1–4. https://doi.org/10.1016/j.jdcr.2023.04.025
Molinelli, E., Sapigni, C., D’Agostino, G. M., Brisigotti, V., Rizzetto, G., Bobyr, I., Cirioni, O., Giacometti, A., Brescini, L., Mazzanti, S., Offidani, A., & Simonetti, O. (2022). The effect of dalbavancin in moderate to severe hidradenitis suppurativa. Antibiotics (Basel), 11(11), 1573. https://doi.org/10.3390/antibiotics11111573
Buimer, M. G., Wobbes, T., & Klinkenbijl, J. H. G. (2009). Hidradenitis suppurativa. British Journal of Surgery, 96(4), 350–360. https://doi.org/10.1002/bjs.6569
Riis, P. T., Ring, H. C., Themstrup, L., & Jemec, G. B. (2016). The role of androgens and estrogens in hidradenitis suppurativa: A systematic review. Acta Dermatovenerologica Croatica, 24(4), 239–249.
Nikolakis, G., Stratakis, C. A., Kanaki, T., Slominski, A., & Zouboulis, C. C. (2016). Skin steroidogenesis in health and disease. Reviews in Endocrine and Metabolic Disorders, 17(3), 247–258. https://doi.org/10.1007/s11154-016-9390-z
Harrison, B. J., Kumar, S., Read, G. F., Edwards, C. A., Scanlon, M. F., & Hughes, L. E. (1985). Hidradenitis suppurativa: Evidence for an endocrine abnormality. British Journal of Surgery, 72(12), 1002–1004. https://doi.org/10.1002/bjs.1800721223
Abu Rached, N., Gambichler, T., Dietrich, J. W., Ocker, L., Seifert, C., Stockfleth, E., & Bechara, F. G. (2022). The role of hormones in hidradenitis suppurativa: A systematic review. International Journal of Molecular Sciences, 23(23), 15250. https://doi.org/10.3390/ijms232315250
Nikolakis, G., Kyrgidis, A., & Zouboulis, C. C. (2019). Is there a role for antiandrogen therapy for hidradenitis suppurativa? A systematic review of published data. American Journal of Clinical Dermatology, 20(4), 503–513. https://doi.org/10.1007/s40257-019-00442-w
Battipaglia, C., Spelta, E., Monterrosa-Blanco, A., & Genazzani, A. D. (2025). The hormonal contraceptive choice in women with polycystic ovary syndrome and metabolic syndrome. GREM - Gynecological and Reproductive Endocrinology & Metabolism, 6, 001–010. https://gremjournal.com/journal/the-hormonal-contraceptive-choice-in-women-with-polycystic-ovary-syndrome-and-metabolic-syndrome
Szyszka, A. (2019). Zalety stosowania spironolaktonu w niewydolności serca u pacjentów z zachowaną frakcją wyrzutową lewej komory. Choroby Serca i Naczyń, 16(1), 28–33. https://doi.org/10.5603/chsin.2019.0001
Gangidi, S. V., Greene, R. K., Olsen, E., Jackson, S., & Nakamura, M. (2024). Efficacy of spironolactone in treating hidradenitis suppurativa in women of childbearing age: A single-center retrospective analysis. International Journal of Women’s Dermatology, 10(3), e159. https://doi.org/10.1097/JW9.0000000000000159
Golbari, N. M., Porter, M. L., & Kimball, A. B. (2019). Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa. Journal of the American Academy of Dermatology, 80(1), 114–119. https://doi.org/10.1016/j.jaad.2018.06.063
Kraft, J. N., & Searles, G. E. (2007). Hidradenitis suppurativa in 64 female patients: Retrospective study comparing oral antibiotics and antiandrogen therapy. Journal of Cutaneous Medicine and Surgery, 11(4), 125–131. https://doi.org/10.2310/7750.2007.00019
Lee, A., & Fischer, G. (2015). A case series of 20 women with hidradenitis suppurativa treated with spironolactone. The Australasian Journal of Dermatology, 56(3), 192–196. https://doi.org/10.1111/ajd.12362
Clark, A. K., Quinonez, R. L., Saric, S., & Sivamani, R. K. (2017). Hormonal therapies for hidradenitis suppurativa: Review. Dermatology Online Journal, 23(10). https://doi.org/10.5070/d32310036990
Joseph, M. A., Jayaseelan, E., Ganapathi, B., & Stephen, J. (2005). Hidradenitis suppurativa treated with finasteride. The Journal of Dermatological Treatment, 16(2), 75–78. https://doi.org/10.1080/09546630510031403
Mota, F., Machado, S., & Selores, M. (2017). Hidradenitis suppurativa in children treated with finasteride: A case series. Pediatric Dermatology, 34(5), 578–583. https://doi.org/10.1111/pde.13216
Babbush, K. M., Andriano, T. M., & Cohen, S. R. (2022). Antiandrogen therapy in hidradenitis suppurativa: Finasteride for females. Clinical and Experimental Dermatology, 47(1), 86–92. https://doi.org/10.1111/ced.14847
Manfredini, M., Alma, A., Pongetti, L., Sticchi, A., Baschieri, E., Farnetani, F., & Pellacani, G. (2022). Topical finasteride: A potential therapeutic option for hidradenitis suppurativa. Dermatologic Therapy, 35(11), e15837. https://doi.org/10.1111/dth.15837
Sabat, R., Chanwangpong, A., Schneider-Burrus, S., Metternich, D., Kokolakis, G., Kurek, A., Philipp, S., Uribe, D., Wolk, K., & Sterry, W. (2012). Increased prevalence of metabolic syndrome in patients with acne inversa. PLoS One, 7(2), e31810. https://doi.org/10.1371/journal.pone.0031810
Shalom, G., Freud, T., Harman-Boehm, I., Polishchuk, I., & Cohen, A. D. (2015). Hidradenitis suppurativa and metabolic syndrome: A comparative cross-sectional study of 3, 207 patients. British Journal of Dermatology, 173(2), 464–470. https://doi.org/10.1111/bjd.13777
Mintoff, D., Benhadou, F., Pace, N. P., & Frew, J. W. (2022). Metabolic syndrome and hidradenitis suppurativa: Epidemiological, molecular, and therapeutic aspects. International Journal of Dermatology, 61(10), 1175–1186. https://doi.org/10.1111/ijd.15910
Phan, K., Charlton, O., & Smith, S. D. (2019). Hidradenitis suppurativa and diabetes mellitus: Updated systematic review and adjusted meta-analysis. Clinical and Experimental Dermatology, 44(4), e126–e132. https://doi.org/10.1111/ced.13922
Verdolini, R., Clayton, N., Smith, A., Alwash, N., & Mannello, B. (2013). Metformin for the treatment of hidradenitis suppurativa: A little help along the way. Journal of the European Academy of Dermatology and Venereology, 27(9), 1101–1108. https://doi.org/10.1111/j.1468-3083.2012.04668.x
Jennings, L., Hambly, R., Hughes, R., Moriarty, B., & Kirby, B. (2020). Metformin use in hidradenitis suppurativa. Journal of Dermatological Treatment, 31(3), 261–263. https://doi.org/10.1080/09546634.2019.1592100
Clinicaltrials.gov. (n.d.). ClinicalTrials.gov. Retrieved July 20, 2025, from https://clinicaltrials.gov/study/NCT04649502
Macklis, P. C., Tyler, K., Kaffenberger, J., Kwatra, S., & Kaffenberger, B. H. (2022). Lifestyle modifications associated with symptom improvement in hidradenitis suppurativa patients. Archives of Dermatological Research, 314(3), 293–300. https://doi.org/10.1007/s00403-021-02233-y
Nicolau, J., Nadal, A., Sanchís, P., Pujol, A., Masmiquel, L., & Nadal, C. (2024). Liraglutide for the treatment of obesity among patients with hidradenitis suppurativa. Medicina Clínica (English Edition), 162(3), 118–122. https://doi.org/10.1016/j.medcli.2023.11.007
Sawers, R. S., Randall, V. A., & Ebling, F. J. (1986). Control of hidradenitis suppurativa in women using combined antiandrogen (cyproterone acetate) and estrogen therapy. British Journal of Dermatology, 115(3), 269–274. https://doi.org/10.1111/j.1365-2133.1986.tb05741.x
Mortimer, P. S., Dawber, R. P., Gales, M. A., & Moore, R. A. (1986). A double-blind controlled cross-over trial of cyproterone acetate in females with hidradenitis suppurativa. British Journal of Dermatology, 115(3), 263–268. https://doi.org/10.1111/j.1365-2133.1986.tb05740.x
Hargis, A., Yaghi, M., Maskan Bermudez, N., & Lev-Tov, H. (2024). Clascoterone in the treatment of mild hidradenitis suppurativa. Journal of the American Academy of Dermatology, 90(1), 142–144. https://doi.org/10.1016/j.jaad.2023.08.064
Cunningham, K. N., Moody, K., Alorainy, M., & Rosmarin, D. (2023). Use of topical clascoterone for the treatment of hidradenitis suppurativa. JAAD Case Reports, 36, 38–39. https://doi.org/10.1016/j.jdcr.2023.04.002
Clinicaltrials.gov. (n.d.-b). ClinicalTrials.gov. Retrieved July 20, 2025, from https://clinicaltrials.gov/study/NCT05914805
Li, C., Xu, H., Zhang, X., Zhang, W., He, Y., & Wang, B. (2018). Hidradenitis suppurativa treated with low-dose flutamide. The Journal of Dermatology, 46(2), 189–190. https://doi.org/10.1111/1346-8138.14541
Masson, R., Shih, T., Jeong, C., Shi, V. Y., & Hsiao, J. L. (2023). Hormonal treatments in hidradenitis suppurativa: A systematic review. Journal of Drugs in Dermatology, 22(8), 785–794. https://doi.org/10.36849/jdd.7325
Camisa, C., Sexton, C., & Friedman, C. (1989). Treatment of hidradenitis suppurativa with combination hypothalamic-pituitary-ovarian and adrenal suppression: A case report. The Journal of Reproductive Medicine, 34(8), 543–546.
Patel, K., Liu, L., Ahn, B., Silfvast-Kaiser, A. S., & Paek, S. Y. (2020). Hidradenitis suppurativa for the non-dermatology clinician. Baylor University Medical Center Proceedings, 33(4), 586–591. https://doi.org/10.1080/08998280.2020.1793643
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