Effectiveness and Safety of Antidiabetic Medications in Hidradenitis Suppurativa: A Systematic Review.

PURPOSE: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition often linked with metabolic dysfunction and insulin resistance. Antidiabetic medications have been explored as adjunctive therapies due to their anti-inflammatory and anti-androgenic effects. This systematic review evaluated the effectiveness and safety of antidiabetic agents in HS management. PATIENTS AND METHODS: A comprehensive search was conducted in PubMed, Scopus, Web of Science, CINAHL Ultimate, and Google Scholar. Eligible studies assessed the efficacy or safety of antidiabetic drugs in HS patients. Fifteen studies, comprising 3721 participants, met inclusion criteria. RESULTS: Metformin was the most studied drug, included in 10 studies. Several investigations showed reductions in HS lesion counts, flare frequency, and disease severity scores (Hurley stage, Sartorius score, Visual Analog Scale). Quality of life improvements, measured by the Dermatology Life Quality Index (DLQI), were observed with metformin, liraglutide, and tirzepatide. Gastrointestinal side effects were the most frequently reported, particularly with metformin. However, no severe or unexpected adverse events were linked to GLP-1 receptor agonists or SGLT2 inhibitors. CONCLUSION: Overall, antidiabetic medications, especially metformin and GLP-1 receptor agonists, appear beneficial for HS. They may reduce disease severity and improve quality of life while maintaining a favorable safety profile. Nevertheless, additional high-quality randomized controlled trials are urgent to confirm these findings.