Hormonal Treatments in Hidradenitis Suppurativa: A Systematic Review
August 2023 | Volume 22 | Issue 8 | 785 | Copyright © August 2023
Published online July 10, 2023
Rahul Masson BSa*, Terri Shih BSb*, Charlotte Jeong BSc, Vivian Y. Shi MDd, Jennifer L. Hsiao MDe
aKeck School of Medicine of USC, University of Southern California, Los Angeles, CA
bDavid Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
cCollege of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
dDepartment of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR
eDepartment of Dermatology, University of Southern California, Los Angeles, CA
Abstract
Background: Hidradenitis suppurativa (HS) is an inflammatory skin condition characterized by recurrent abscesses, nodules, and sinus tracts. Hormones are thought to play an important role in HS pathophysiology, but there is a lack of an updated review on hormonal treatments in HS.
Objective: Perform a systematic review of the literature on hormonal treatments in patients with HS.
Methods: In April 2022, MEDLINE and EMBASE databases were searched for articles on hormonal treatments in HS. Non-English, duplicate, and irrelevant results were excluded. Data extraction was performed by two reviewers.
Results: From 1952 to 2022, 30 articles (634 patients) met the inclusion criteria. Anti-androgen treatments discussed include finasteride (n=8), spironolactone (n=7), cyproterone acetate (CPA) (n=5), flutamide (n=1), leuprolide (n=1), and buserelin acetate (n=1). Metabolic treatments reported include metformin (n=8) and liraglutide (n=2). Three articles on hormonal contraceptives and 2 articles on testosterone were included. Of the articles which reported response rates, 62.8% (27/43) of patients improved with finasteride, 53.3% (32/60) with CPA mono/combination therapy, 50.5% (51/101) with spironolactone, and 46.0% (74/161) with metformin. Improvement in HS was also noted in case reports of patients treated with buserelin acetate, leuprolide, flutamide, and liraglutide.
Conclusions: Hormonal treatments for HS, especially finasteride, spironolactone, and metformin, are efficacious and safe; but large-scale randomized controlled trials are needed to determine the patient populations which would benefit from these therapies. Masson R, Shih T,
Jeong C, et al. Hormonal treatments in hidradenitis suppurativa: a systematic review. J Drugs Dermatol. 2023;22(8):785-794. doi:10.36849/JDD.7325
INTRODUCTION
Hidradenitis suppurativa (HS) is a chronic, oftentimes debilitating inflammatory skin condition characterized by abscesses, inflammatory nodules, sinus tracts, and scarring.1 Existing data suggest multifactorial etiology with genetic, hormonal, and immune dysregulating factors.1 A hormonal component to HS is supported by typical onset of disease after puberty, fluctuations in disease activity during menses and pregnancy, and HS comorbidities such as metabolic syndrome and polycystic ovarian syndrome (PCOS).2-6 Given that women of child-bearing age are disproportionately affected by HS,7 understanding the effects of different hormonal treatments on HS symptoms is critical. Herein, we conducted a systematic review to evaluate existing literature on the efficacy and safety of hormonal therapies in HS.
MATERIALS AND METHODS
Search Strategy
This study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was pre-registered on PROSPERO (CRD42021283596). On April 25, 2022, two independent reviewers (RM and CJ) searched MEDLINE and EMBASE databases from inception to search date with the following terms: ("hidradenitis suppurativa" OR "hidradenitis" OR "acne inversa" OR "Verneuil disease" OR "Velpeau disease") AND ("hormone" OR "hormonal" OR "estrogen" OR "progesterone" OR "progestin" OR "testosterone" OR "antiandrogen" OR "metformin" OR "spironolactone" OR "contraceptive" OR "finasteride" OR "cyproterone acetate" OR "dutasteride" OR "intrauterine device" OR "medroxyprogesterone acetate" OR "clascoterone").
