What are the systemic treatments for hand eczema (atopic dermatitis) and hidradenitis suppurativa?

From the Guidelines

For systemic treatment of hand eczema and hidradenitis suppurativa, dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib are recommended as first-line options, as they have shown strong evidence of efficacy in reducing inflammation and improving quality of life, as supported by the most recent guidelines 1. When considering systemic treatment for hand eczema and hidradenitis suppurativa, it is essential to weigh the benefits and risks of each medication. The following options are considered:

• Dupilumab, tralokinumab, abrocitinib, baricitinib, and upadacitinib, which have strong recommendations for use in atopic dermatitis and may be beneficial for hand eczema and hidradenitis suppurativa, as they target different aspects of inflammation and immune dysregulation 1.
• Adalimumab, which is FDA-approved for hidradenitis suppurativa and has shown good efficacy in clinical trials, with an initial dose of 160 mg, then 80 mg at week 2, followed by 40 mg weekly 1.
• Oral retinoids like acitretin or isotretinoin, which may help reduce inflammation and normalize skin cell turnover, but require regular monitoring due to potential side effects, such as teratogenicity 1.
• Antibiotics like doxycycline or a combination of clindamycin and rifampin, which can control bacterial involvement in hidradenitis suppurativa, but should be used for limited periods to minimize antibiotic resistance 1. It is crucial to note that the decision to initiate these treatments should be made using shared decision-making between patients and clinicians, taking into account the severity of the condition, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 1. Regular monitoring is essential to minimize potential side effects and ensure the best possible outcomes.

From the FDA Drug Label

Hidradenitis Suppurativa (HS) (1.8): treatment of moderate to severe hidradenitis suppurativa in patients 12 years of age and older. Hidradenitis Suppurativa (2. 6): Adults:◦ Day 1: 160 mg (given in one day or split over two consecutive days)◦ Day 15: 80 mg ◦ Day 29 and subsequent doses: 40 mg every week or 80 mg every other week

Systemic treatment for hand eczema is not mentioned.

• Hidradenitis suppurativa is treated with adalimumab (SQ) in patients 12 years of age and older.
• The dosage for hidradenitis suppurativa in adults is 160 mg on Day 1,80 mg on Day 15, and 40 mg every week or 80 mg every other week starting on Day 29. 2

From the Research

Systemic Treatment for Hand Eczema and Hidradenitis

• There are various systemic treatments available for hidradenitis suppurativa, including antibiotics, retinoids, and biologics 3, 4, 5, 6, 7
• For moderate-to-severe hidradenitis suppurativa, systemic therapies such as adalimumab, secukinumab, and bimekizumab have been approved and have expanded treatment options 3, 4, 7
• Other systemic treatments, including cyclosporine, infliximab, and oral prednisone, may be used for severe cases of hidradenitis suppurativa 5, 7
• The choice of systemic treatment depends on the severity and extent of the disease, as well as the presence of comorbidities and the patient's quality of life 3, 6
• A multimodal approach to treatment, including topical and systemic therapies, lifestyle modifications, and surgical treatment, may be necessary for optimal management of hidradenitis suppurativa 6

Systemic Therapies for Hidradenitis Suppurativa

• Adalimumab, a TNF-alpha blocker, has been shown to be effective in improving quality of life and reducing symptoms of hidradenitis suppurativa 3, 4, 7
• Infliximab, another TNF-alpha blocker, has also been shown to be effective in improving quality of life and reducing symptoms of hidradenitis suppurativa 5, 7
• Secukinumab and bimekizumab, IL-17 inhibitors, have been approved for the treatment of moderate-to-severe hidradenitis suppurativa 3
• Other systemic therapies, including antibiotics and retinoids, may be used as first-line or second-line treatments for hidradenitis suppurativa 4, 5

Treatment Algorithm for Hidradenitis Suppurativa

• A comprehensive and updated algorithm for the management of hidradenitis suppurativa has been proposed, incorporating newly available literature and expert opinion 6
• The algorithm includes a multimodal approach to treatment, with consideration of disease severity, extent, and impact on quality of life, as well as comorbidity screening and treatment stacking of topical and systemic therapies 6