Failure of Anti-interleukin-1 Therapy in Severe Hidradenitis Suppurativa: a Case Report

Hidradenitis suppurativa (HS) is an inflammatory, debilitating skin disease of follicular origin, characterized by painful deep-seated, inflamed lesions in mainly the inverse areas of the body. HS is notoriously difficult to treat and especially severe disease is often resistant to therapy. New therapeutic options are therefore highly needed. Elevated levels of IL-1 have been demonstrated in HS lesions. Here we report for the first time on the sequential treatment with anakinra (an IL-1 receptor antagonist) and golimumab (a TNF-α-neutralizing antibody) of a patient with severe HS and with comorbid psoriatic arthritis. Although adalimumab and golimumab were efficacious in improving arthritis complaints, both failed in improving the severe HS of our patient. Eventually the patient underwent radical excision of the inflammatory lesions and fistulas.