BACKGROUND: Several studies report the use of tumor necrosis factor alpha 
(TNF-alpha) inhibitors in refractory hidradenitis suppurativa (HS), particularly 
infliximab and etanercept. However, very limited data have been reported for 
adalimumab, the newest fully human anti-TNF-alpha monoclonal antibody. We 
evaluated the long-term efficacy and safety of adalimumab therapy in 6 patients 
with refractory HS. In the case of positive culture findings from any draining 
lesion, antibiotic therapy was administered for at least 2 weeks before 
initiating adalimumab therapy. Adalimumab (in 40-mg subcutaneous injections) was 
prescribed every other week. If the disease was inadequately controlled, the 
dosage was increased to 40 mg/wk. If HS was in persistent clinical remission, 
adalimumab therapy was gradually decreased to 40 mg every 3 weeks. Quality of 
life was assessed using the Dermatology Life Quality Index.
OBSERVATIONS: Six patients (mean [SD] age, 39.3 [12.9] years) with severe HS 
(mean [SD] duration, 22.5 [11.7] years) were treated with adalimumab. 
Significant improvements after 1 month of treatment were seen in the Dermatology 
Life Quality Index; in the number of affected regions, nodules, and fistulas; 
and in the basic laboratory findings. Improvements were maintained for a mean 
(SD) follow-up of 21.5 (7.1) (range, 13-29) months. Adalimumab was well 
tolerated. Conclusion Adalimumab appears to be an effective and safe treatment 
for refractory HS.