SYSTEMATIC REVIEW OF PHARMACOTHERAPY STRATEGIES IN THE MANAGEMENT OF HIDRADENITIS SUPPURATIVA

Introduction: Hidradenitis suppurativa (HS, acne inversa) is a chronic, recurrent inflammatory dermatosis with an etiopathogenesis that remains not fully understood. Characteristic skin lesions—nodules, abscesses, sinus tracts, and scars—are most commonly located in skin fold areas, leading to a significant deterioration in patients’ quality of life, both physically and psychosocially. Despite advances in medical knowledge, the diagnosis of HS is often delayed, and treatment represents a major clinical challenge requiring individualized therapeutic approaches. This article provides a review of current literature on pharmacological treatment strategies for HS, including both topical and systemic therapies. Particular emphasis is placed on antibiotic therapy (e.g., tetracyclines, combination therapy with clindamycin and rifampicin, triple-drug regimens, ertapenem), as well as hormonal and immunomodulatory treatments. Furthermore, the growing role of biologic therapies, including TNF-α and interleukin inhibitors, and the use of emerging targeted agents under investigation are discussed. Attention is also drawn to the importance of androgen receptors and their potential role in the pathogenesis of HS, as reflected in the effectiveness of antiandrogen therapies (e.g., spironolactone or oral contraceptives containing a progestogenic component). The review includes data on the efficacy, safety, and limitations of various therapeutic methods based on clinical trials and systematic reviews. The need for further research on the skin microbiome and immune response mechanisms is highlighted, as it may serve as a basis for the development of new, more targeted therapeutic interventions. It is emphasized that HS treatment should be multidimensional and tailored to disease severity as well as coexisting metabolic and endocrine disorders. Materials and Methods: The article was written based on scientific papers available on PubMed and Google Scholar Key findings: Analysis of current evidence indicates that pharmacotherapy constitutes a fundamental component in the management of hidradenitis suppurativa (HS), with treatment outcomes strongly dependent on disease severity. Biological therapies, including adalimumab, secukinumab, and belimumab, have demonstrated significant clinical efficacy in moderate to severe HS, particularly in individuals unresponsive to conventional therapies, and represent a major advancement in disease management. Antibiotics remain widely used, providing symptomatic relief despite HS being a chronic inflammatory rather than an infectious condition. Topical clindamycin (1%) is effective in mild cases with superficial inflammatory lesions but shows limited efficacy in deep nodules and carries a risk of microbial resistance. Systemic antibiotic therapy, especially clindamycin combined with rifampicin, has achieved clinical remission in a substantial proportion of moderate HS cases, whereas severe disease may require intensified regimens, including metronidazole, rifampicin, moxifloxacin, or intravenous ertapenem; however, relapse rates following treatment discontinuation remain high. Anti-androgen therapies, such as spironolactone, finasteride, cyproterone acetate (CPA), and metformin, have demonstrated beneficial effects in women with hormonally driven flares or hyperandrogenic comorbidities. Novel topical and systemic anti-androgen agents (finasteride, flutamide, clascoterone, leuprolide) are currently under investigation, but high-quality randomized controlled trials are Conclusions: Hidradenitis suppurativa remains a significant therapeutic challenge, with current pharmacological strategies providing only partial and often temporary disease control. Biologic agents offer substantial clinical improvement in refractory moderate to severe HS, whereas antibiotics and anti-androgen therapies remain valuable options in mild to moderate disease, albeit with limitations such as high relapse rates and potential adverse effects, including antimicrobial resistance. The complex and incompletely understood pathophysiology of HS highlights the urgent need for further research into immunologic, microbial, and hormonal pathways to facilitate the development of targeted and personalized treatment approaches.