Original article
Hidradenitis suppurativa (HS): An unrecognized paradoxical effect of biologic agents (BA) used in chronic inflammatory diseases

https://doi.org/10.1016/j.jaad.2016.01.018Get rights and content

Background

Paradoxical hidradenitis suppurativa (HS) induced by biologic agents (BA) is scarcely reported.

Objective

We sought to describe the clinical characteristics and outcome of patients developing paradoxical HS under BA.

Methods

This was a multicenter nationwide retrospective study asking physicians to report all cases of HS, confirmed by a dermatologist, occurring during treatment of an inflammatory disease by a BA.

Results

We included 25 patients (15 inflammatory rheumatism, 9 Crohn's disease, 1 psoriasis) treated by 5 BA (adalimumab = 12, infliximab = 6, etanercept = 4, rituximab = 2, tocilizumab = 1). Median duration of BA exposure before HS onset was 12 (range 1-120) months. Patients were mostly Hurley stage I (n = 13) or II (n = 11). Simultaneously to HS or within 1 year, 11 patients developed additional inflammatory diseases, including paradoxical reactions (psoriasis = 9, Crohn's disease = 3, alopecia areata = 1, erythema elevatum diutinum = 1). Complete improvement of HS was more frequently obtained after BA discontinuation or switch (n = 6/10, 60%) rather than maintenance (n = 1/14, 7%). Reintroducing the same BA resulted in HS relapse in 3 of 3 patients.

Limitations

Retrospective nature and lack of complete follow-up for some patients are limitations.

Conclusion

HS is a rare paradoxical adverse effect of BA, but fortuitous association cannot be excluded in some cases. We observed a trend toward better outcome when the BA was discontinued or switched.

Section snippets

Methods

From November 1, 2013, to July 4, 2015, we performed a nationwide retrospective multicenter study, asking dermatologists and rheumatologists to report all cases of HS that occurred for the first time in patients receiving BA for a chronic inflammatory disease. A standardized questionnaire was available on the World Wide Web site of the Club Rheumatisms and Inflammation and the French Society of Dermatology. The diagnosis of HS had to be confirmed by a dermatologist. The study was approved by

Results

From May 2004 to July 2015, in 12 centers we recorded 25 patients who developed HS while receiving BA (20 female, 5 male) (Table I). Two patients had a family history of HS, 52% were smokers, 36% had a body mass index 30 or higher, and 60% had a body mass index 25 or higher. Inflammatory rheumatisms (rheumatoid arthritis, n = 7; ankylosing spondylitis, n = 5; psoriatic arthritis, n = 1; synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome, n = 1; chronic juvenile arthritis,

Discussion

De novo onset of HS after administration of BA for chronic inflammatory diseases has been reported on only 2 occasions.8, 9 We present a series of 25 additional similar cases, suggesting that this condition may be underreported. A search of the national pharmacosurveillance registry yielded no additional case and showed that only 5 of these 25 cases had been reported to the registry.

Our patients shared demographic features with those reported for HS (ie, female predominance, smoking, overweight

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    Funding sources: None.

    Disclosure: Authors reported conflicts with AbbVie (APV, VB, JM, DJ), Astellas (VB), Amgen (DJ), BMS (FA, VB, JM), Galderma (FA), Gedeon (VB), Hospira (JM), Janssen (FA, JM, DJ), Leo Pharma (FA), Lilly (DJ), MSD (DJ), Nordic Pharma (JM), Novartis (FA), Pfizer (VB, JM, DJ), Roche (FA, VB, JM, DJ), Sobi (DJ), UCB (JM).

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