Adalimumab Dose Intensification in Recalcitrant Hidradenitis Suppurativa/Acne Inversa

Dermatology. 2020;236(1):25-30. doi: 10.1159/000503606. Epub 2019 Oct 18.


Background: Adalimumab is the only approved compound for the treatment of adult patients with moderate-to-severe hidradenitis suppurativa (HS) who did not respond to a systemic classical treatment. Despite its significant short- and long-term efficacy, a percentage of patients do not respond sufficiently. Moreover, some primary responders experience a response loss with time.

Objective: To analyse the effectiveness of adalimumab dose intensification in HS patients.

Methods: A case series of adalimumab 80 mg/week subcutaneously (s.c.) compassionate use in patients with HS, who did not respond sufficiently or in primary responders with progressive response loss to the registered adalimumab dose of 40 mg/week s.c. Patients were collected and evaluated retrospectively. Patients' data were extracted from medical records.

Results: The 14 patients collected were Caucasian with HS of Hurley stage II-III and moderate or severe International HS Severity Score System (IHS4) stage. Adalimumab dose intensification significantly improved IHS4 score, Pain Index, HS-Physician Global Assessment, pain, and Cardiff Dermatology Life Quality Index. Two young female patients with HS and Crohn's disease developed psoriatic lesions during the treatment with adalimumab 80 mg/week s.c.

Conclusion: An enhanced level of effectiveness was assessed in the majority of the HS patients treated with adalimumab dose intensification (80 mg/week s.c.). Larger studies are required to evaluate this observation.

Keywords: Acne inversa; Adalimumab; Hidradenitis suppurativa; Intensification; Treatment.

MeSH terms

  • Adalimumab / administration & dosage*
  • Adult
  • Dermatologic Agents / administration & dosage*
  • Dose-Response Relationship, Drug
  • Female
  • Hidradenitis Suppurativa / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Severity of Illness Index
  • Young Adult


  • Dermatologic Agents
  • Adalimumab