Successful control of hidradenitis suppurativa with verapamil: a case report

An inappropriate immunologic response has been suggested to play a role in the pathogenesis of hidradenitis suppurativa (HS). Adalimumab was the first TNF‐α inhibitor approved for moderate to severe HS. We report on a case of HS (Hurley stage 2) in a 39‐year‐old man, who had received fusidic acid and isotretinoin treatments without evident benefit during the last 8 years. The patient noticed a reduction in the number of lesions and quality of life (DLQI from 27 to 6) in the 2 months following verapamil initiation for cluster headache. When verapamil was stopped, the lesions recurred within 1.5 months. The patient resumed taking verapamil as before and a remission occurred. Verapamil has been shown to inhibit TNF‐α and IL‐1β in vitro and in vivo. We hypothesize that verapamil inhibits the inflammatory process through the TNF‐α/IL‐1 pathway involved in the HS physiopathology. Compared to biologic agents as anti‐TNF‐α (adalimumab) and anti‐IL1 (anakinra), verapamil is safer and cheaper. Given its possible role on TNF‐α/IL‐1, verapamil may represent an alternative therapeutic option in mild and moderate HS.