P128 Florid psoriasis in a patient with psoriatic arthritis and hidradenitis suppurativa: therapeutic challenges

Abstract Hidradenitis suppurativa is a chronic inflammatory disorder that affects the skin. It causes recurring inflammatory lesions which may leave permanent scarring. The disease may be autoinflammatory. Hidradenitis suppurativa has been reported to emerge in patients with spondylarthritis, such as ankylosing spondylitis or psoriatic arthritis. The aim was to describe the case of a male patient who had psoriatic arthritis and developed hidradenitis suppurativa. A patient, male, aged 47 presented with psoriatic arthritis. He was on treatment with a TNFa inhibitor with good response as far as the arthritis was concerned. At the age of 51 he developed hidradenitis suppurativa with lesions in the axillary region bilaterally and under the lower ­mandible. Adalimumab was administered with partial remission of both psoriatic arthritis and hidradenitis suppurativa. However, as psoriatic arthritis was active in the axial skeleton with florid psoriasis and sacroiliitis was present bilaterally secukinumab 150 mg/month was initiated. Thereafter the dose of secukinumab was increased to 300 mg/month. Hidradenitis suppurativa lesions improved significantly. However, the pain in the axial skeleton remained intense. Hidradenitis suppurativa is a chronic inflammatory condition, which may be autoinflammatory in its pathogenesis. Hidradenitis suppurativa may appear in patients with spondylarthritis or psoriatic arthritis. Biologic agents are now applied in the management of hidradenitis suppurativa and appear to be effective. We describe the case of a patient with psoriatic arthritis and hidradenitis suppurativa who was treated effectively with biologic agents. The application of biologic agents in the treatment of hidradenitis suppurativa may shed light on the pathogenesis of the disease.