Antiandrogen therapy with spironolactone for the treatment of hidradenitis suppurativa

Background Hormonal therapy is a potential treatment for hidradenitis suppurativa (HS). However, few data exist describing the efficacy of spironolactone in treatment of HS. Objective To assess whether spironolactone treatment improves HS disease severity and patient-reported pain. Methods We performed a single-center chart review of female patients with HS who were treated with spironolactone between 2000 and 2017. Primary outcome measurements included the HS Physician's Global Assessment (HS-PGA), Hurley staging, inflammatory lesion count, fistula count, and a numeric rating scale for pain. Results On average, subjects were exposed to 75 mg of spironolactone daily over a 7.1-month follow-up period. Patients achieved significant disease improvement with regard to pain (Δ-1.5 [ P  = .01]), inflammatory lesions (Δ-1.3 [ P  = .02]), and HS-PGA score (Δ-0.6 [ P P  = .32]) or fistulas (Δ0 [ P  = .73]). There was no difference in improvement between subjects who received less than 75 mg of spironolactone daily (n = 25; average dose, 45 mg/d) and those who received more than 100 mg daily (n = 21; average dose, 112 mg/d). Limitations Retrospective nature, limited sample size, and variations in severity measures documented were limiting factors. Conclusions Management of HS with spironolactone reduces lesion count, HS-PGA score, and pain. Lower doses appear to be effective and may be an appropriate option for patients with tolerability concerns.