Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

Publication date: Available online 10 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Nicole M. Golbari, Martina L. Porter, Alexa B. Kimball

Abstract

Background

Hormonal therapy is a potential treatment for hidradenitis suppurativa (HS). However, little data exists describing the efficacy of spironolactone in HS treatment.

Objective

To assess whether spironolactone treatment improves HS disease severity and patient reported pain.

Methods

We performed a single center chart review of female HS patients treated with spironolactone between 2000 and 2017. Primary outcome measurements included the HS Physician Global Assessment (HSPGA), Hurley Staging, inflammatory lesion count, fistula count, and a numeric rating scale for pain.

Results

Subjects on average were exposed to 75mg of spironolactone daily over a 7.1-month follow-up period. Patients achieved significant disease improvement with regards to pain (Δ-1.5, P=.01), inflammatory lesions (Δ-1.3, P=.02), and HSPGA (Δ-0.6, P<.001). As expected, no change was found for Hurley stage (Δ0, P=.32) or fistulas (Δ0, P=.73). There was no difference in improvement between subjects who received less than 75mg daily (n= 25, average 45mg/day) and those who received greater than 100mg daily (n=21, average 112mg/day).

Limitations

Retrospective nature, limited sample size, and variations in severity measures documented were limiting factors.

Conclusions

Management of HS with spironolactone reduces lesion count, HSPGA and pain. Lower doses appear to be effective and may be an appropriate option for patients with tolerability concerns.