Title : Facial hidradenitis suppurativa secondary to exogenous testosterone successfully treated with secukinumab: A case report
Abstract:
Background: Hidradenitis Suppurativa (HS) is a chronic inflammatory disorder of the follicular–apocrine unit, predominantly affecting intertriginous regions. Facial involvement is rare but can cause substantial cosmetic and psychosocial morbidity. Although biologics have transformed HS management, treatment failure remains common.
Purpose: To report a case of testosterone-induced facial HS refractory to adalimumab but successfully treated with secukinumab, and to discuss the role of IL-17 blockade in atypical or refractory HS.
Case presentation: A 30-year-old male developed mandibular nodules and abscesses shortly after initiating exogenous testosterone. He failed multiple systemic therapies, including prednisone, isotretinoin, dapsone, intralesional corticosteroids, and six months of adalimumab. Given refractory disease in a cosmetically sensitive area, secukinumab was initiated (standard loading then every-2-week maintenance).
Results: By week 16, the patient achieved near-complete clearance with marked pain relief, leaving only post-inflammatory scarring. At 12-month follow-up, he remained in sustained remission without adverse effects. Literature indicates only scattered reports of cervicofacial HS treated with infliximab, ustekinumab, or surgery, but none describing durable remission on secukinumab in testosterone-induced disease. This appears to be the first such report.
Conclusion: Facial HS can present as a refractory and cosmetically challenging phenotype, particularly when triggered by exogenous testosterone. IL-17 inhibition with secukinumab may provide effective disease control after adalimumab failure. Earlier consideration of IL-17 blockade may be warranted in severe or atypically distributed HS.
