Original article
Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

https://doi.org/10.1016/j.jaad.2018.06.063Get rights and content

Background

Hormonal therapy is a potential treatment for hidradenitis suppurativa (HS). However, few data exist describing the efficacy of spironolactone in treatment of HS.

Objective

To assess whether spironolactone treatment improves HS disease severity and patient-reported pain.

Methods

We performed a single-center chart review of female patients with HS who were treated with spironolactone between 2000 and 2017. Primary outcome measurements included the HS Physician's Global Assessment (HS-PGA), Hurley staging, inflammatory lesion count, fistula count, and a numeric rating scale for pain.

Results

On average, subjects were exposed to 75 mg of spironolactone daily over a 7.1-month follow-up period. Patients achieved significant disease improvement with regard to pain (Δ-1.5 [P = .01]), inflammatory lesions (Δ-1.3 [P = .02]), and HS-PGA score (Δ-0.6 [P < .001]). As expected, no change was found for Hurley stage (Δ0 [P = .32]) or fistulas (Δ0 [P = .73]). There was no difference in improvement between subjects who received less than 75 mg of spironolactone daily (n = 25; average dose, 45 mg/d) and those who received more than 100 mg daily (n = 21; average dose, 112 mg/d).

Limitations

Retrospective nature, limited sample size, and variations in severity measures documented were limiting factors.

Conclusions

Management of HS with spironolactone reduces lesion count, HS-PGA score, and pain. Lower doses appear to be effective and may be an appropriate option for patients with tolerability concerns.

Section snippets

Methods

An institutional board review–approved retrospective review of adult patients with diagnosis of HS (according to International Classification of Diseases, Ninth Revision, code 705.83 or International Classification of Diseases, 10th Revision, code L73.2) who were treated with spironolactone at Beth Israel Deaconess Medical Center between 2000 and 2017 was performed. The 145 patients identified by the Clinical Data Repository search included 67 female subjects (Fig 1).

Demographic data, baseline

Baseline characteristics

A total of 67 female patients for whom spironolactone had been prescribed for treatment of HS were identified. A total of 21 patients were lost to follow-up after the initial visit. The baseline data were similar between the groups with and without follow-up. The average age at initial presentation of the 46 patients with at least 1 follow-up was 35.1 years (standard deviation [SD], 10.3). The mean age was 21.4 years (SD, 10.1) at disease onset and 31.1 years at diagnosis (SD, 9.4).

Discussion

The patients in this study who were treated for HS with spironolactone achieved significant decreases in lesion count, HS-PGA score, and pain. As expected, Hurley score (which is a static staging score based on scarring) and fistulas (which tend to be permanent epithelialized tracts) did not change over the course of treatment. It is worth noting that fistula count did not increase over the follow-up period.

Our results demonstrated reductions in HS-PGA score and lesion count similar to those

References (15)

There are more references available in the full text version of this article.

Cited by (0)

Funding sources: None.

Disclosure: Dr Porter has received fellowship funding from Abbvie and Janssen. Dr Kimball serves as a consultant and investigator to Novartis, Abbvie, and UCB. Ms Golbari has no conflicts of interests to disclose.

Ms Golbari and Dr Porter had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis, as well as for drafting of the manuscript and for statistical analysis. Drs Porter and Kimball were responsible for the study concept and design, as well as for critical revision of the manuscript for important intellectual content. Dr Kimball was responsible for study supervision.

Reprint requests: [email protected].

View full text
© 2018 by the American Academy of Dermatology, Inc.