The Contradictory Inefficacy of Methotrexate in Hidradenitis Suppurativa: A Need to Revise Pathogenesis or Acknowledge Disease Heterogeneity?

The Contradictory Inefficacy of Methotrexate in Hidradenitis Suppurativa: A Need to Revise Pathogenesis or Acknowledge Disease Heterogeneity? J Dermatolog Treat. 2019 Apr 04;:1-8 Authors: Frew JW Abstract The pathogenesis of Hidradenitis Suppurativa (HS) centers around Th17/Treg dysfunction illustrated by lesional elevation of IL-17A, IL-6, and other inflammatory mediators resulting in a chronic feed-forward inflammatory cascade. Similar inflammatory mechanisms have been identified in psoriasis and rheumatoid arthritis (RA) in which traditional immunosuppressants (including methotrexate) are routinely used with reasonable levels of disease control. Methotrexate's mechanism of action in these instances include downregulation of the Th17 axis via alterations in dendritic cell and T-cell activity and maturation. Published data suggests methotrexate in an ineffective therapy in HS, which does not pair with our current understanding of the mechanisms of disease. The reasons behind this, including are discussed. Some HS patients may benefit from drugs such as methotrexate, and acknowledgement of the potential of disease heterogeneity will allow exploration of which factors may enable identification of such individuals. PMID: 30945961 [PubMed - as supplied by publisher]
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research