1 Iconography
Access to the text (HTML) Access to the text (HTML)
PDF Access to the PDF text

Access to the full text of this article requires a subscription.
  • If you are a subscriber, please sign in 'My Account' at the top right of the screen.

  • If you want to subscribe to this journal, see our rates

Journal of the American Academy of Dermatology
Volume 74, n° 6
pages 1153-1159 (juin 2016)
Doi : 10.1016/j.jaad.2016.01.018
accepted : 12 January 2016
Original Articles

Hidradenitis suppurativa (HS): An unrecognized paradoxical effect of biologic agents (BA) used in chronic inflammatory diseases

Coline Faivre, MD a, , Axel Patrice Villani, MD a, François Aubin, MD, PhD h, Dan Lipsker, MD, PhD b, Martine Bottaro, MD j, Jean-David Cohen, MD l, François Durupt, MD, PhD k, Géraldine Jeudy, MD c, Emilie Sbidian, MD, PhD d, Eric Toussirot, MD, PhD i, Valérie Badot, MD, PhD m, Sébastien Barbarot, MD, PhD e, Sébastien Debarbieux, MD f, Emmanuel Delaporte, MD, PhD g, Guetty Goegebeur, MD n, Jacques Morel, MD, PhD o, Aude Nassif, MD p, Gérard Duru, PhD a, Denis Jullien, MD, PhD a
on behalf of the

French Society of Dermatology and Club Rheumatisms and Inflammation

a Dermatology Department, Hôpital Edouard Herriot, Université Claude Bernard Lyon I, Lyon, France 
b Dermatology Department, Centre Hospitalo-Universitaire (CHU) de Strasbourg, Université de Strasbourg, Strasbourg, France 
c Dermatology Department, CHU de Dijon, Dijon, France 
d Dermatology Department, CHU Henri-Mondor, Créteil, France 
e Dermatology Department, CHU Hôtel Dieu, Nantes, France 
f Dermatology Department, Center Hospitalier Lyon-Sud, Lyon, France 
g Dermatology Department, Hôpital Claude-Huriez, Université Lille II, Lille, France 
h Dermatology Department, Hôpital Saint-Jacques, Université de Franche-Comté, Besançon, France 
i Clinical Investigation Center for Biotherapy, Institut National de la Santé et de la Recherche Médicale (INSERM) Centre d'Investigation Clinique (CIC) 1431 and Rheumatology, Université de Franche-Comté, Besançon, France 
j Rheumatology Department, Center Hospitalier de Valence, Valence, France 
k Dermatology Department, Center Hospitalier de Valence, Valence, France 
l Rheumatology Department, CHU Lapeyronie, Montpellier, France 
m Rheumatology Department, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium 
n Hepatogastroenterology Department, Center Hospitalier Loire Vendée Océan, Challans, France 
o Rheumatology Department, CHU Lapeyronie, Université de Montpellier, Montpellier, France 
p Infectious Diseases Center Necker-Pasteur, Pasteur Institute, Assistance Publique-Hôpitaux de Paris, Paris, France 

Reprint requests: Coline Faivre, MD, Dermatology Department, Hôpital Edouard Herriot, 5 place d'arsonval, 69003 Lyon, France.Dermatology DepartmentHôpital Edouard Herriot5 place d'arsonvalLyon69003France

Paradoxical hidradenitis suppurativa (HS) induced by biologic agents (BA) is scarcely reported.


We sought to describe the clinical characteristics and outcome of patients developing paradoxical HS under BA.


This was a multicenter nationwide retrospective study asking physicians to report all cases of HS, confirmed by a dermatologist, occurring during treatment of an inflammatory disease by a BA.


We included 25 patients (15 inflammatory rheumatism, 9 Crohn's disease, 1 psoriasis) treated by 5 BA (adalimumab = 12, infliximab = 6, etanercept = 4, rituximab = 2, tocilizumab = 1). Median duration of BA exposure before HS onset was 12 (range 1-120) months. Patients were mostly Hurley stage I (n = 13) or II (n = 11). Simultaneously to HS or within 1 year, 11 patients developed additional inflammatory diseases, including paradoxical reactions (psoriasis = 9, Crohn's disease = 3, alopecia areata = 1, erythema elevatum diutinum = 1). Complete improvement of HS was more frequently obtained after BA discontinuation or switch (n = 6/10, 60%) rather than maintenance (n = 1/14, 7%). Reintroducing the same BA resulted in HS relapse in 3 of 3 patients.


Retrospective nature and lack of complete follow-up for some patients are limitations.


HS is a rare paradoxical adverse effect of BA, but fortuitous association cannot be excluded in some cases. We observed a trend toward better outcome when the BA was discontinued or switched.

The full text of this article is available in PDF format.

Key words : biologic agents, hidradenitis suppurativa, paradoxical reactions, tumor necrosis factor-alfa inhibitors

Abbreviations used : BA, HS, IL, TNF

 Funding sources: None.
 Disclosure: Authors reported conflicts with AbbVie (APV, VB, JM, DJ), Astellas (VB), Amgen (DJ), BMS (FA, VB, JM), Galderma (FA), Gedeon (VB), Hospira (JM), Janssen (FA, JM, DJ), Leo Pharma (FA), Lilly (DJ), MSD (DJ), Nordic Pharma (JM), Novartis (FA), Pfizer (VB, JM, DJ), Roche (FA, VB, JM, DJ), Sobi (DJ), UCB (JM).

© 2016  American Academy of Dermatology, Inc.@@#104156@@
EM-CONSULTE.COM is registrered at the CNIL, déclaration n° 1286925.
As per the Law relating to information storage and personal integrity, you have the right to oppose (art 26 of that law), access (art 34 of that law) and rectify (art 36 of that law) your personal data. You may thus request that your data, should it be inaccurate, incomplete, unclear, outdated, not be used or stored, be corrected, clarified, updated or deleted.
Personal information regarding our website's visitors, including their identity, is confidential.
The owners of this website hereby guarantee to respect the legal confidentiality conditions, applicable in France, and not to disclose this data to third parties.
Article Outline
You can move this window by clicking on the headline