Efficacy of high-dose intralesional triamcinolone for hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of hair follicles characterized by recurrent, painful nodules, abscesses, and sinus tracts ("tunnels") typically refractory to treatment. This debilitating condition results in poor quality of life due to high disease burden. Intralesional triamcinolone (ILTAC) is a standard of care for acute inflammation and drainage associated with HS; however, the optimal therapeutic dose has not been determined. We investigated the utility of high-dose ILTAC 20 mg/ml (ILTAC-20) or 40 mg/ml (ILTAC-40), for inflammatory lesions of HS.

A retrospective chart review and telephone questionnaire included HS patients treated with high-dose ILTAC-20 or ILTAC-40 between April and December 2018. Patients with Hurley stages I-III were included. Data were obtained from electronic medical records and telephone interviews. A short questionnaire pertained to satisfaction with therapy, changes of disease state, and modifications in quality of life.

Of 54 patients interviewed, the average age was 36.9 ± 11.6 years; 36 (66.7%) were female. Forty patients (76.9%) were very satisfied (n = 19) or satisfied (n = 21) with high-dose ILTAC therapy. Fifty patients (92.6%) demonstrated improvements in disease state, and 41 patients (75.9%) experienced enhanced quality of life. Forty-four patients (86.3%) were amenable to additional injections of high-dose ILTAC, if clinically indicated. No adverse effects of therapy were reported.

The majority of patients reported improvements in disease state, quality of life, and overall satisfaction after administration of high-dose ILTAC (20-40 mg/ml). These findings support the use of high-dose ILTAC for acute lesions of HS.