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Is There a Role for Antiandrogen Therapy for Hidradenitis Suppurativa? A Systematic Review of Published Data

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Abstract

Background

Hidradenitis suppurativa/acne inversa is a disease with deep-seated chronic painful nodules, abscesses, and draining sinus tracts, which manifests on the apocrine gland-rich skin areas of the body. Observational findings demonstrate that the disease usually appears after puberty, exhibits pre-menstrual flares in women, improves in pregnancy, and worsens post-partum, which indicates a role of hormones and particularly of androgens in its pathophysiology. Because increased androgen levels in serum have not been widely reported, an end-organ androgen hypersensitivity has been postulated.

Objective

The aim of this systematic review was to identify and present evidence for antiandrogen therapeutic options for the treatment of hidradenitis suppurativa/acne inversa.

Methods

A literature search was conducted in different medical electronic databases using the keywords “hidradenitis”, “suppurativa”, “acne inversa”, and “antiandrogen” on 1 December, 2018. The main therapeutic options were subsequently used as separate keywords with the disease terms in a separate search.

Results

The main therapeutic options yielded were cyproterone acetate, spironolactone, finasteride, and metformin. One randomized controlled crossover trial and seven case series were identified following use of a standard extraction form for eligibility.

Conclusion

The existing studies do not allow a robust evidence-based recommendation for the use of antiandrogens in the treatment of hidradenitis suppurativa/acne inversa. Further randomized controlled trials are needed to define the role of hormonal treatment as an alternative or concomitant therapy together with antibiotics or biologics.

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Authors and Affiliations

  1. Departments of Dermatology, Venereology, Allergology and Immunology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Auenweg 38, 06847, Dessau, Germany

    Georgios Nikolakis, Athanassios Kyrgidis & Christos C. Zouboulis

  2. Department of Evidence-Based Dermatology, Dessau Medical Center, Brandenburg Medical School Theodor Fontane, Dessau, Germany

    Athanassios Kyrgidis & Christos C. Zouboulis

  3. European Hidradenitis Suppurativa Foundation e.V., Dessau, Germany

    Georgios Nikolakis, Athanassios Kyrgidis & Christos C. Zouboulis

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  1. Georgios Nikolakis
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  2. Athanassios Kyrgidis
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  3. Christos C. Zouboulis
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Correspondence to Georgios Nikolakis.

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Funding

This work was an investigator-initiated project and was not supported by any financial means.

Conflict of interest

Christos C. Zouboulis has received honoraria from AbbVie for participation as an advisor and speaker, and from Idorsia, Inflarx, Novartis, and UCB for participation as an advisor. His department has received grants from AbbVie, Inflarx, Novartis, and UCB for his participation as an investigator. Georgios Nikolakis and Athanassios Kyrgidis have no conflicts of interest that are directly relevant to the content of this article.

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Nikolakis, G., Kyrgidis, A. & Zouboulis, C.C. Is There a Role for Antiandrogen Therapy for Hidradenitis Suppurativa? A Systematic Review of Published Data. Am J Clin Dermatol 20, 503–513 (2019). https://doi.org/10.1007/s40257-019-00442-w

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