Background Acne inversa (AI), also known as suppurative hidradenitis (HS), is a chronic, inflammatory, recurrent disease that is difficult to manage with the usual standard treatment, especially in the advanced stage of the disease. So the use of factors modulating the inflammatory response such as adalimumab may constitute a new therapeutic option.

Purpose To evaluate the efficacy and safety of adalimumab in the treatment of severe AI.

Materials and methods Retrospective cross-sectional study of patients diagnosed with AI (Hurley grade III) and adalimumab subcutaneous until August 2013. In all cases, informed consent was obtained (off-label indication). The data were obtained from the clinical history and computerised outpatient dispensing program. The efficacy of adalimumab was defined as clinical improvement in the affected regions, nodules and/or fistulas compared to the usual standard treatment (oral antibiotics, corticosteroids, antiandrogens and/or retinoids).

Results Six patients were included, 2 men and 4 women, with a mean age of 28.8 ± 8.6 years (range: 17–39). The mean treatment duration was 4.8 ± 2.7 months (range: 1–9). In men, the affected regions were the genitals and the groin, while in women they were the armpits and groin. In one case, the affected area was not reflected in the medical history. 3 patients were active smokers. All patients had been treated previously with oral antibiotics, combined or not with antiandrogens, corticosteroids and/or isotretinoin and none had previously received a biological therapy. Only in one case there was a positive family history of the disease. 4 patients received loading doses of 160 and 80 mg administered subcutaneously at week 0 and 1, respectively (without interval) and 2 patients received loading dose of 80 mg at week 0. The maintenance regimen was 40 mg weekly except in 2 cases it was every other week, one because of severe headaches. All patients reported improvement with decreased drainage from all affected sites, remaining stable during the follow-up period. No significant adverse effects were reported.

Conclusions Adalimumab may represent a new alternative in the management of severe AI with an acceptable safety profile, despite being administered at high doses during the induction phase and without a weekly break; the long-term benefit/risk of adalimumab is unknown.

No conflict of interest.