Most of the strongest treatments for hidradenitis suppurativa (HS), including the injectable biologics making news lately, are designed for moderate to severe disease. For people with milder HS, the toolkit is much thinner. No topical treatment has ever been FDA-approved specifically for the condition, and a new study suggests a cream could eventually fill that gap.
As reported by Dermatology Times, a phase 2 trial published in the Journal of the American Academy of Dermatology tested ruxolitinib 1.5% cream, a topical treatment already sold as Opzelura for other skin conditions, in 69 adults with mild to moderate HS.
What the study found
Participants had Hurley stage I or II disease, with no draining tunnels. They applied either ruxolitinib or a cream without the active ingredient twice a day.
By week 16, 79 percent of people using ruxolitinib had at least a 50 percent reduction in inflamed bumps and abscesses, with no increase in abscesses or draining tunnels. In the comparison group, 50 percent had the same response. After that, everyone could continue into an extension phase, applying ruxolitinib as needed. Response rates remained high through week 32, though this phase had no comparison group.
Peterborough, Ontario, Canada dermatologist Melinda Gooderham, MD, medical director at SKiN Centre for Dermatology and senior author of the study, said in a statement: “This phase 2 study is important because it moves the HS treatment conversation earlier in the disease course. For patients with Hurley I/II disease without draining tunnels, ruxolitinib cream showed reductions in inflammatory lesions, fewer flares, sustained benefit, and a reassuring safety profile. This study supports further investigation of topical JAK inhibition as a targeted, nonantibiotic approach for milder HS, and phase 3 trials are ongoing.”
How it held up on safety
The cream was generally well tolerated in this small trial. Reported side effects included upper respiratory infections and reactions where the cream was applied. No major cardiovascular events were reported, but a study of 69 people cannot rule out uncommon risks.
What this could mean for milder HS
The usual topical options for early HS, such as antibiotic creams, resorcinol and antiseptic washes, have limited research behind them, and none directly target the immune signals driving the inflammation. Ruxolitinib takes a different approach. As a JAK inhibitor, it targets inflammatory signaling and doesn’t carry the bacterial-resistance concerns that come with topical antibiotics.
It may eventually offer another option for people with milder HS. The cream isn’t approved for HS yet, and phase 3 trials are underway. If you’re managing milder HS, ask your dermatologist what the findings could mean for your treatment options.
