Holistic Management of Treatment-Resistant Hidradenitis Suppurativa: A Cost-Effective Alternative to Biologics - A Case Report

Background: Adalimumab, the sole FDA-approved biologic for hidradenitis suppurativa (HS), demonstrates limited long-term efficacy with treatment resistance developing in approximately 40-60% of patients, while costing ₹240,000-360,000 annually in India. This case explores the potential of holistic intervention as a cost-effective alternative. Case Presentation: A 54-year-old female with severe HS experienced no improvement after two years of adalimumab therapy, presenting with open wounds, purulent discharge, and significant pain affecting quality of life. Following adalimumab discontinuation, a comprehensive holistic protocol was implemented including complete dairy elimination, stress management through yoga and exercise, lymecycline 408mg daily for one month with antioxidant supplementation for six months, and sequential topical therapy (benzoyl peroxide wash, mupirocin until wound healing, then isotretinoin 0.025%). Outcomes: Complete wound healing was achieved within 8 weeks, with sustained remission for 6 months representing the longest disease-free period in the patient's history. No adverse effects were reported, and significant improvement in mental state and motivation was observed. Total treatment cost was approximately ₹12,000 (<5% of adalimumab therapy). Conclusion: This case demonstrates that evidence-based holistic approaches can achieve superior clinical outcomes to expensive biologics in treatment-resistant HS, offering a reproducible, cost-effective therapeutic paradigm with potential for widespread healthcare implementation.