More than 50 interventions have been used to treat hidradenitis suppurativa 
(HS), and so therapy decisions can be challenging. Our objective was to 
summarize and appraise randomized controlled trial (RCT) evidence for HS 
interventions in adults. Searches were conducted in Medline, Embase, CENTRAL, 
LILACS, five trials registers and abstracts from eight dermatology conferences 
until 13 August 2015. Two review authors independently assessed study 
eligibility, extracted data and assessed methodological quality. Primary 
outcomes were quality of life and adverse effects of the interventions. Twelve 
trials, from 1983 to 2015, investigating 15 different interventions met our 
inclusion criteria. The median trial duration was 16 weeks and the median number 
of participants was 27. Adalimumab 40 mg weekly improved the Dermatology Life 
Quality Index (DLQI) by 4·0 points, which equates to the minimal clinically 
important difference for the scale, compared with placebo (95% confidence 
interval -6·5 to -1·5 points). Evidence quality was reduced to 'moderate' 
because the results are based on only a single study. Adalimumab 40 mg every 
other week was ineffective in a meta-analysis of two studies comprising 124 
participants. Infliximab 5 mg kg(-1) improved the DLQI score by 8·4 points after 
8 weeks in a moderate-quality study completed by 33 of 38 participants. 
Etanercept 50 mg twice weekly was ineffective. Inclusion of a gentamicin sponge 
prior to primary closure did not improve outcomes. Other interventions, 
including topical and oral antibiotics, were investigated by relatively small 
studies, preventing treatment recommendations due to imprecision. More, larger 
RCTs are required to investigate most HS interventions, particularly oral 
treatments and surgical therapy. Moderate-quality evidence suggests that 
adalimumab given weekly and infliximab are effective, whereas adalimumab every 
other week is ineffective.