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Summary   Background  Biologics targeting inflammatory mediators can achieve clinical improvements in hidradenitis suppurativa ( HS ). However, their clinical efficacy shows great interpatient variability in daily practice.    Objectives  To investigate the anti‐inflammatory potency of a selection of currently available biologics and prednisolone for the treatment of  HS  in an  ex vivo  skin culture system using lesional  HS  biopsies.    Methods  Lesional skin samples from 10 patients with  HS  and skin samples from five healthy controls were cultured  ex vivo  and exposed to prednisolone or biologics targeting tumour necrosis factor ( TNF )‐α, interleukin ( IL )‐17A,  IL ‐12/23p40 or  CD 20 (adalimumab, infliximab, secukinumab, ustekinumab and rituximab, respectively). Real‐time quantitative polymerase chain reaction and cytokine bead arrays were used to measure the inhibitory effect of the biologics on cytokines and antimicrobial peptides ( AMP s).    Results  The relative  mRNA  expression of all tested cytokines and  AMP s was significantly downregulated by all anti‐inflammatory agents ( P  < 0·001). The protein production of the proinflammatory cytokines  TNF ‐α, interferon γ,  IL ‐1β,  IL ‐6 and  IL ‐17A was significantly inhibited by adalimumab, infliximab, ustekinumab, prednisolone (all  P  < 0·001) and rituximab ( P  = 0·0071), but not by secukinumab ( P  = 0·0663). On both  mRNA  and protein levels, adalimumab, infliximab and prednisolone reduced the levels of a broader mix of individual cytokines than secukinumab, ustekinumab and rituximab. Moreover, a significant inhibitory effect on  mRNA  expression levels of inflammatory markers in healthy control skin was observed only for  TNF ‐α inhibitors ( P  < 0·001) and prednisolone ( P  = 0·0015).    Conclusions  This  ex vivo  study suggests that  TNF ‐α inhibitors and prednisolone are the most powerful inhibitors of proinflammatory cytokines and  AMP s in  HS  lesional skin, which concurs with our clinical experience in patients with  HS .

british journal of dermatology

The anti‐inflammatory potency of biologics targeting tumour necrosis factor‐α, interleukin ( IL )‐17A,  IL ‐12/23 and  CD 20 in hidradenitis suppurativa: an  ex vivo  study