Dual Blocking of IL17A and IL36R for the Treatment of Refractory Hidradenitis Suppurativa: A Case Report.

Hidradenitis suppurativa (HS), a chronic inflammatory disorder affecting approximately 1% of the global population, remains challenging to treat due to the limited efficacy of single biologics (TNFa/IL-17/IL-36 inhibitors) against draining tunnels (dTs). A man with refractory HS (Hurley stage III) was treated with recibokibart (anti-IL36R antibody) and secukinumab (anti-IL17A antibody). Disease severity was assessed using previously validated clinical outcome measures and ultrasonography. Rapid clinical improvement was observed in this patient. HiSCR50 was achieved at week 2, and HiSCR100 (complete resolution of inflammatory nodules and abscesses without new dTs) by week 10. The pain score decreased from 8 to 2, and the exudation resolved. The size of the tunnels in the four intertrigonal areas was significantly reduced, as assessed by ultrasound. This case highlights the synergistic potential of dual IL-17/IL-36 blockade, particularly for dTs, and offers a novel therapeutic strategy for treating severe HS.