Hidradenitis suppurativa: on the issue of rational therapy

The article presents a series of clinical cases of management of patients with chronic suppurative hidradenitis (CSH) in the Clinic of the Ural Research Institute of Dermatovenereology and Immunopathology. The modern classification of CSH according to Hurley (1989), with 3 degrees of severity of the disease, the most accepted in clinical practice, is presented. Standard therapy for CSH to date includes antibiotics of various groups, systemic retinoids, glucocorticosteroids, antiandrogenic drugs, active anti-inflammatory, antibacterial topical therapy. In the treatment of CSH, surgical interventions are also used, which are most often implemented in the superficial opening of inflammatory foci, drainage of purulent tracts and sinuses, less often in local excision of foci and scars, including using laser surgery, which is carried out in the case of a long and severe course of CSH. At the same time, routine practice shows that the listed methods of therapy have only a moderate and temporary effect, without preventing further progradient development of the disease. The authors’ observations of patients with CSH presented in the article confirm this statement. With the clarification of the role of proinflammatory cytokines in the development of inflammation in CSH, the formation of fistulas and scars, new data on the significant role of proinflammatory cytokines in the pathogenesis of CSH, such as tumor necrosis factor α, interleukin-17 (IL-17), IL-1, IL-10, IL-23 have appeared. In practice, additional and effective agents from the class of genetically engineered biological preparations have appeared; they inhibit the above-mentioned cytokines and allow to significantly alleviate the course of the disease, which was demonstrated in a patient with a severe course of hidradenitis. The introduction of modern methods of therapy into clinical practice will significantly prolong clinical remission and improve the quality of life in patients of this group.