Hidradenitis suppurativa is a chronic disease that affects the apocrine 
gland-bearing regions of the body. The etiology of this disorder is poorly 
understood, but most likely is a complex process involving follicular apocrine 
occlusion with subsequent perifolliculitis. Many treatment options have been 
reported with varying degrees of success, including topical and oral therapy and 
surgical procedures. Recently, TNF-alpha antagonists have been reported as 
effective therapy in a few patients. We report here a patient who initially 
responded to infliximab but developed an infusion reaction to this medication. 
After subsequent treatment with adalimumab, the patient's disease improved 
dramatically and has been maintained under excellent control for over 15 months. 
We propose that TNF-alpha inhibitors, particularly monoclonal antibody based 
agents, are a viable treatment option in patients with severe, recalcitrant HS 
and that a patient may be safely and successfully treated with the fully human 
monoclonal antibody adalimumab in cases in which the chimeric monoclonal 
antibody infliximab therapy is not tolerated.