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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 24  |  Issue : 2  |  Page : 133-134

Effectiveness of adalimumab in combination with intense pulsed light and radiofrequency therapy (LAight®) for severe hidradenitis suppurativa: A case report


1 Dermatology Practice, Dr. Uwe Kirschner, Mainz, Germany
2 Department of Dermatology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
3 Department of Dermatology, University of Münster, Münster, Germany

Date of Submission11-Jul-2019
Date of Acceptance02-Jan-2020
Date of Web Publication10-Nov-2020

Correspondence Address:
Dr. Sophia Zimmer
Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Langenbeckstr. 1, 55131 Mainz
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdds.jdds_36_19

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  Abstract 


Hidradenitis suppurativa (HS also named as acne inversa) is a chronic skin disease characterized by relapsing formation of abscesses, inflammatory nodules, and fistulas. In moderate-to-severe disease, HS leads to the formation of scarring and thus irreversible tissue destruction. In the past few years, two new treatment options became available: adalimumab, the first biologic therapy approved for HS (Humira®, AbbVie), and a noninvasive, device-based treatment utilizing a combination of intense pulsed light and radiofrequency (LAight® therapy, LENICURA, Germany). Here, we report a case of a Hurley stage III patient where the positive effect of adalimumab could be enhanced by simultaneously applying LAight® therapy. Moreover, long-term symptom control could be achieved under monotherapy with LAight® after adalimumab was terminated.

Keywords: Adalimumab, hidradenitis suppurativa, LAight® therapy


How to cite this article:
Kirschner U, Lang BM, Steinbrink K, Zimmer S. Effectiveness of adalimumab in combination with intense pulsed light and radiofrequency therapy (LAight®) for severe hidradenitis suppurativa: A case report. J Dermatol Dermatol Surg 2020;24:133-4

How to cite this URL:
Kirschner U, Lang BM, Steinbrink K, Zimmer S. Effectiveness of adalimumab in combination with intense pulsed light and radiofrequency therapy (LAight®) for severe hidradenitis suppurativa: A case report. J Dermatol Dermatol Surg [serial online] 2020 [cited 2020 Dec 4];24:133-4. Available from: https://www.jddsjournal.org/text.asp?2020/24/2/133/300392




  Introduction Top


Hidradenitis suppurativa (HS) is a debilitating chronic skin disease characterized by the formation of abscesses, inflammatory nodules, and fistulas.[1],[2]

Surgical interventions can induce long-term symptom control. However, taking into account, the cumbersome healing process surgery may not be the optimal choice for every patient. Medical treatments can successfully reduce symptoms, however, bear side effects and discontinuation is often associated with a relapse in disease symptoms.[3],[4],[5]

Here, we report a case of a Hurley stage III patient where the long-term symptom control could be achieved after adalimumab was terminated applying a combination of intense pulsed light (IPL) and radiofrequency (RF) (LAight®).


  Case Report Top


A 46-year-old male presented with a severe Hurley stage III HS. Even though the disease onset was at the age of 16 years, it was the first time, he received a proper diagnosis. He showed lesions in both axillae and groins and the scrotum but most severely in the buttocks area [Figure 1]a. At the same time, he had symptoms of acne vulgaris in the face and the shoulder belt. As a concomitant disease, he suffered from a monoclonal gammopathy, regularly controlled by hematologists. The patient was a smoker with a body mass index of 25.
Figure 1: (a) Start of the treatment with adalimumab (December 2015), (b) after 3 months monotherapy with adalimumab (March 2016), (c) after 22 months of adalimumab and 19 months of intense pulsed light and radiofrequency (October 2017), (d) after 17 months additional monotherapy with intense pulsed light and radiofrequency (March 2019)

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Treatment history for HS includes several topical and oral antibiotics (clindamycin, dapsone, ciprofloxacin, and metronidazole) as well as several series of retinoids (isotretinoin and acitretin) which all failed to control symptoms. Between 2003 and 2013, the patient underwent ten extensive surgeries which left him with considerable mental traumatization and showed no lasting effect. The patient reported that especially, the malodors of the lesions, as well as the pain, affected his quality of life (QoL) very severely.

At the beginning of December 2015, the patient was started on adalimumab. Lesions and associated pain improved significantly, while no considerable side effects were noted. However, the patient reported a stagnation of improvement after 3 months and still complained about the smell of the lesions [Figure 1]b.

Starting at the end of March 2016, the patient was additionally treated biweekly with an irradiation therapy combining IPL and RF.

Lesions continued to improve under this combined treatment strategy, and in December 2016, the patient reported a well-tolerable pain level. Most important to him was the diminished malodor which severely had impaired his QoL.

In October 2017, the patient decided to stop medication with adalimumab, after almost 2 years of treatment [Figure 1]c. At that time, the QoL had improved dramatically. The Dermatology QoL Index (DLQI) questionnaire[6] yielded two points, and the numeric rating scale for pain yielded three points. From July 2016, the distance between the IPL + RF treatment had been extended to 3–4 weeks but was now changed back to every other week buffering potential relapsing symptoms after the stop of the biological treatment.

After discontinuation of adalimumab, we observed newly inflamed lesions, increased DLQI (five points), and a spike of pain (seven points). These effects subsided after 8 weeks under continued biweekly treatment with IPL + RF therapy without further intervention. In March 2018, another flare of lesions was treated with doxycycline (100 mg per day) for 20 days. The patient was then exclusively treated with IPL + RF therapy, neither antibiotics nor pain medication were needed. At the final evaluation point in March 2019, the DLQI and pain levels were measured at two and four points, respectively [Figure 1]d.


  Discussion Top


While literature already suggests that laser therapy should be considered as adjuvant therapy for HS, the NICE trial showed that especially, the combination of IPL with RF can successfully improve the HS disease symptoms.[7] The presented case indicates that the combination of adalimumab and IPL + RF therapy is a beneficial therapeutic option for patients suffering from severe HS with a stagnation of recovery under biological monotherapy. Moreover, the case demonstrates that IPL + RF treatment exhibits the potential to maintain the remission achieved under biological treatment if the latter has to be terminated. Even though slightly painful, IPL + RF treatment can be carried out without anesthesia and so far mild, local, and temporary skin irritations are the only observed side effects.[7]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gill L, Williams M, Hamzavi I. Update on hidradenitis suppurativa: Connecting the tracts. F1000Prime Rep 2014;6:112.  Back to cited text no. 1
    
2.
Revuz J. Hidradenitis suppurativa. J Eur Acad Dermatol Venereol 2009;23:985-98.  Back to cited text no. 2
    
3.
Mendonça CO, Griffiths CE. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol 2006;154:977-8.  Back to cited text no. 3
    
4.
Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol 1998;39:971-4.  Back to cited text no. 4
    
5.
Hazen PG, Hazen BP. Hidradenitis suppurativa: Successful treatment using carbon dioxide laser excision and marsupialization. Dermatol Surg 2010;36:208-13.  Back to cited text no. 5
    
6.
Basra MK, Salek MS, Camilleri L, Sturkey R, Finlay AY. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): Further data. Dermatology 2015;230:27-33.  Back to cited text no. 6
    
7.
Wilden S, Friis M, Tuettenberg A, Staubach-Renz P, Wegner J, Grabbe S, et al. Combined treatment of hidradenitis suppurativa with intense pulsed light (IPL) and radiofrequency (RF). J Dermatolog Treat 2019. p. 1-8.  Back to cited text no. 7
    


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