Pharmacological development in hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating disease of a relapsing nature which presents with nodules, abscesses, and suppurating lesions of intertriginous areas of the skin. Within recent years, there has been significant progress in terms of the treatment of HS, nevertheless, an unmet need of treatment exists and effective therapy remains a serious challenge. The current treatment strategies are focused on known pathomechanisms underlying and responsible for development of HS lesions, including hyperkeratinization and occlusion of pilosebaceous unit, dysbiosis and the extensive, chronic inflammation. Several cytokines (i.e. TNF-a, IL-1, IL-17, and IL-23) seem to be involved in HS pathogenesis, and their blockade appears as a rational therapeutic approach. So far TNF inhibition with adalimumab remains the only EMA-approved/FDA-approved agent in HS treatment and should be consequently considered first. Other drugs, however, play an increasing role in off-label therapy. In recent years, new phase II and III trials for HS management have appeared aimed at inhibition of specific targetable inflammatory pathways identified in HS. Thus, several new biologics are being investigated, including MABp1 (bermekimab), CJM112, bimekizumab, guselkumab, secukinumab, and IFX-1.