Journal of cutaneous medicine and surgery
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Case Reports
Successful treatment of hidradenitis suppurativa with infliximab in a patient who failed to respond to etanercept.
Hidradenitis suppurativa (HS) is a devastating chronic scarring disease of the axillae, groins, and submammary tissue occurring predominantly in women, with onset at puberty. Multiple treatments have been attempted, with limited success. The association of HS with Crohn disease, psoriasis (PSO), and pyoderma gangrenosum, as well as the seronegative arthropathies, suggests a common immunopathogenesis and has motivated attempts at treatment with anti-tumor necrosis factor (TNF)-alpha agents, already demonstrated to be efficacious in major inflammatory diseases. ⋯ The success of anti-TNF agents such as infliximab in managing HS offers a new therapeutic option and supports an underlying immunologic basis for the disease. The differential response to HS observed with infliximab and etanercept in this patient could be related to differences in structure, binding specificities, or gene suppression.
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Postinflammatory hyperpigmentation (PIH) commonly occurs in Fitzpatrick skin types III to VI and can have a considerable impact on quality of life. The majority of cases will improve spontaneously, but this can take months or even years to resolve and in some cases can be permanent. Treatment may be prolonged, lasting 6 to 12 months or longer for adequate restoration of normal pigmentation. ⋯ More randomized controlled clinical studies in large numbers of PIH patients are needed to provide standardized measurable outcomes in this indication.