Small Case Series Shows Promise for Topical Roflumilast in HS Treatment

KEY TAKEAWAYS

• A small prospective case series found topical roflumilast 0.3% cream improved lesions and symptoms in mild HS.

• Patients treated with once-daily roflumilast reported relief from itch, pain, and drainage.

• No adverse events were reported.

A prospective case series published in JAAD Case Reports suggests that once-daily topical roflumilast 0.3% cream may be a promising off-label treatment for mild hidradenitis suppurativa (HS).

Conducted by researchers at the George Washington University School of Medicine and Health Sciences, the study followed three female patients with Hurley stage I HS over a 60-day period. All patients used topical roflumilast once daily and were assessed for objective nodule count and patient-reported symptoms (pain, itch, odor, and drainage).

All three patients had reduced lesion counts by day 30, and by day 60, all achieved complete resolution. Symptom relief, including alleviation of pain and itch, occurred rapidly within the first month and was maintained throughout the study. No adverse events were reported.

Topical roflumilast, a PDE-4 inhibitor approved for plaque psoriasis, modulates inflammatory signaling pathways implicated in HS, including the Th1 and Th17 axes. Prior reports have suggested benefit with oral roflumilast in severe HS, but this is the first prospective study to evaluate topical use in mild cases.

“Patients with mild HS are often overlooked and cycle through antibiotics and steroids that may not provide sustained relief,” said Adam J. Friedman, MD, senior author and Chair of Dermatology at George Washington University, in a news release about the study. “These results indicate topical roflumilast could represent a safer, targeted alternative.”

Sources:

GWU press release. December 17, 2025. 

Adusumilli N, et al. JAAD Case Reports. 2025. Doi:10.1016/j.jdcr.2025.12.016