BACKGROUND: Hidradenitis suppurativa (HS) is characterized by chronic, 
suppurative abscesses, sinus tracts, and fistulas affecting the axilla, groin, 
and perianal region resulting from hyperkeratosis and occlusion of the terminal 
hair follicle.
OBJECTIVE: This report highlights the use of biologic agents for the treatment 
of recalcitrant HS.
METHOD: We report on a 48-year-old male with a 15-year history of refractory 
perianal-inguinal-buttock HS who, despite receiving numerous surgical drainages 
and traditional medical treatment for HS, still had severe pain. After trialing 
etanercept and infliximab with methotrexate, the patient had marked improvement 
with adalimumab. A literature review of biologics therapy was also performed.
RESULTS: After trialing many traditional therapies, we found that adalimumab 
appears to be the most effective treatment modality for our patient. A 
literature search revealed 53 articles on biologics therapy in HS. These 
articles are summarized.
DISCUSSION: Biologic agents have been shown to have variable results in the 
treatment of refractory HS. Enough low-grade evidence has been accumulated to 
make the use of these agents suitable in HS. Until more clinical trials are 
performed on this topic, physicians should use clinical judgment when treating 
HS with biologic agents and be cautious by watching for significant adverse 
effects.