TNF inhibitors for Refractory Dissecting Cellulitis — Donovan Hair Clinic
The PGA score decreased from 3 to 1. The median number of inflammatory nodules decreased from 7 to 0.5. The median number of abscesses decreased from 1 to 0.
The DLQI decreased slightly from 10 to 8 and the NRS score for pain severity and 6 to 1.
Overall, the median treatment satisfaction was 7 out of 10.
TNF inhibitors were stopped in 8 of the 26 (31 %) patients. 18 of 26 continued these treatments (69%). Reasons for stopping included optic neuritis, elevated liver enzymes elevation. Two patients were in remission and 3 demonstrated moderate efficacy and stopped. 1 was lost to follow-up.
This is one of the largest series of TNF inhibitor use of DSC. After treatment with a TNF inhibitor, symptoms and quality of life improved significantly, and the patients were overall satisfied.
It is interesting to note that even though the mean satisfaction index was 7.25 out of 10, the DLQI only dropped from 10 to 8. The DLQI examines effects on quality of life, embarrassment, sexual health, ability of work, ability to participate in leisure and hobbies. It would appear that even though there has been improvement in pain and abscesses, there remains some permeant dysfunction and permanent alteration in quality of life. This speaks to the need for early diagnosis and aggressive treatment.
This data supports the effectiveness of anti-TNF medications in treating DCS in patients who do not respond to conventional treatments. I put it on the list as a second line agent.