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Case Reports
. 2018 Jun 1:6:2050313X18778723.
doi: 10.1177/2050313X18778723. eCollection 2018.

Hidradenitis suppurativa with SAPHO syndrome maintained effectively with adalimumab, methotrexate, and intralesional corticosteroid injections

Erika L Crowley  1   2 , Ashley O'Toole  1 , Melinda J Gooderham  1   3   4
Affiliations
Case Reports

Hidradenitis suppurativa with SAPHO syndrome maintained effectively with adalimumab, methotrexate, and intralesional corticosteroid injections

Erika L Crowley et al. SAGE Open Med Case Rep. .

Abstract

Introduction: Hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome are chronic, debilitating diseases involving apocrine gland-bearing skin inflammation and bone inflammation, respectively. Although both often present with multiple comorbidities, single patient co-presentation is rare.

Methods/results: This study reports the 8-year treatment course of a 40-year-old man with hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome, and reviews relevant literature. Initial oral and topical antibiotics had little effect. Intralesional corticosteroid injections were effective for localized inflammatory lesions but insufficient for hidradenitis suppurativa control. Adalimumab initiation and local excision of a persistent HS lesion led to stabilization. Adalimumab provided dramatic back pain improvement. Synovitis, acne, pustulosis, hyperostosis, osteitis was diagnosed; adalimumab continuation with subsequent methotrexate addition resulted in hidradenitis suppurativa-synovitis, acne, pustulosis, hyperostosis, osteitis control.

Conclusions: Literature regarding comorbid hidradenitis suppurativa and synovitis, acne, pustulosis, hyperostosis, osteitis syndrome therapy is scarce but growing. Adalimumab, methotrexate, intralesional corticosteroid, and lifestyle changes successfully maintained a severe hidradenitis suppurativa-synovitis, acne, pustulosis, hyperostosis, osteitis-syndrome case. Further studies beyond a case-based review could yield more definitive treatment plans.

Keywords: Dermatology; Hidradenitis suppurativa; SAPHO syndrome; adalimumab; intralesional corticosteroid injections; methotrexate.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Erika L Crowley and Ashley O’Toole have no conflicts to disclose. Melinda J Gooderham has been a speaker, advisory board member and/or clinical investigator for AbbVie, Amgen, Boehringer Ingleheim, Celgene, Dermira, Galderma, Janssen, Kyowa Kirin, Leo Pharma, Medimmune, Novartis, Pfizer, Regeneron, Roche, Sanofi Genzyme, UCB, and Valeant.

References

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