INTRODUCTION
Hidradenitis suppurativa (HS) is an inflammatory, debilitating, skin follicular disease that usually presents after puberty with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas of the body, most commonly in the axillary, inguinal, and anogenital areas.1 HS decreases patients’ quality of life, and patients with HS are at increased risk for psychiatric comorbidities, substance use disorders, and suicide completion.2 There are a variety of HS treatments available; however, their efficacy is limited.3
Treatment of HS is guided by disease severity and includes topical antibiotics, oral antibiotics, biologic medications, and procedures.4 Nevertheless, evidence from randomized controlled trials is limited for most of these interventions,5 and individuals’ responses to first-line treatment varies based upon patient factors such as age and smoking status.6 In a study of 139 patients with HS, a clinical response was achieved by 60% of patients treated with doxycycline and 46% of patients treated with rifampicin-clindamycin, both of which are firstline systemic medications.7 Another factor that may impact patient’s use of conventional medicine is out-of-pocket cost.8
Adalimumab, a TNF-alpha inhibitor frequently used to treat immune-mediated diseases such as rheumatoid arthritis, is also an acceptable long term therapy for moderate to severe HS.9 In 2019, the projected annual out-of-pocket cost for adalimumab prescribed to patients with rheumatoid arthritis was $5,168, an amount that may be unacceptably high for some patients.10
A limited response to first-line treatments and the high cost of medication may leave HS patients seeking options other than conventional medicine. One such option is alternative medicine; the lifetime prevalence of complementary or alternative medicine (AM) use in dermatologic patients is between 35 to 69%.11 Patients often seek non-prescription therapies due to perceived prescription failure.12 In a survey of 303 patients with HS, 255 (84.2%) reported AM use, most commonly citing reasons of “frustration with conventional treatment†and a desire to try “new†or “more natural†treatments.13 Of the 255 patients who reported AM use, 166 reported at least mild success.13 Despite a high rate of AM use among patients with HS, few studies have characterized these patients or explored factors that may contribute to their use of alternative therapies.
Treatment of HS is guided by disease severity and includes topical antibiotics, oral antibiotics, biologic medications, and procedures.4 Nevertheless, evidence from randomized controlled trials is limited for most of these interventions,5 and individuals’ responses to first-line treatment varies based upon patient factors such as age and smoking status.6 In a study of 139 patients with HS, a clinical response was achieved by 60% of patients treated with doxycycline and 46% of patients treated with rifampicin-clindamycin, both of which are firstline systemic medications.7 Another factor that may impact patient’s use of conventional medicine is out-of-pocket cost.8
Adalimumab, a TNF-alpha inhibitor frequently used to treat immune-mediated diseases such as rheumatoid arthritis, is also an acceptable long term therapy for moderate to severe HS.9 In 2019, the projected annual out-of-pocket cost for adalimumab prescribed to patients with rheumatoid arthritis was $5,168, an amount that may be unacceptably high for some patients.10
A limited response to first-line treatments and the high cost of medication may leave HS patients seeking options other than conventional medicine. One such option is alternative medicine; the lifetime prevalence of complementary or alternative medicine (AM) use in dermatologic patients is between 35 to 69%.11 Patients often seek non-prescription therapies due to perceived prescription failure.12 In a survey of 303 patients with HS, 255 (84.2%) reported AM use, most commonly citing reasons of “frustration with conventional treatment†and a desire to try “new†or “more natural†treatments.13 Of the 255 patients who reported AM use, 166 reported at least mild success.13 Despite a high rate of AM use among patients with HS, few studies have characterized these patients or explored factors that may contribute to their use of alternative therapies.
