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The clinical course included HS flares with concurrent diarrhea, fatigue, amenorrhea, and hot flashes consistent with menopause onset, with partial improvement after combined clindamycin, spironolactone, and minocycline.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/androgenic-hidradenitis-suppurativa-onset-linked-to-gamma-secretase-inhibitor/453085/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/androgenic-hidradenitis-suppurativa-onset-linked-to-gamma-secretase-inhibitor/453085.png","ImageObject",300,407,{"name":42,"@type":43},"Lucas Martin","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-07","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the reported relationship between nirogacestat and hidradenitis suppurativa in this case?","Question",{"text":63,"@type":64},"HS-like lesions emerged after about 6 months of nirogacestat therapy, suggesting a temporal link between gamma-secretase inhibition and HS onset.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What symptoms occurred alongside the HS flares during nirogacestat treatment?",{"text":68,"@type":64},"Concomitant adverse effects included diarrhea, fatigue, amenorrhea, and daily hot flashes consistent with menopause onset.",{"name":70,"@type":61,"acceptedAnswer":71},"How was HS treated after the patient presented to the dermatology center?",{"text":72,"@type":64},"HS activity was reduced with topical chlorhexidine wash plus clindamycin gel, together with oral spironolactone and minocycline.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},453085,1792579794,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":55,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":110,"preview_page_count":4},8796095360427,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","CASE REPORT  \nAndrogenic hidradenitis suppurativa onset linked to gamma secretase inhibitor  \nHansen Tai, BA,a ,b Khyla T. Hill, BA, MBS,a ,c Aarthi Parvathaneni, BS, BA,a ,d Zahidul Islam, BA,e and  \nSteven R. Cohen, MD, MPHa  \nKey words: amenorrhea; androgen; desmoid tumor; gamma secretase inhibitor; hidradenitis suppurativa; menopause; nicastrin; nirogacestat; notch signaling; ovarian failure; presenilin; spironolactone; therapy.  \nINTRODUCTION  \nHidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of follicular origin, primarily affecting areas with apocrine gland-bearing skin. Recurrent painful nodules, abscesses, and sinus tracts characterize advanced HS. It leads to scarring, malodor, and intractable draining wounds, significantly impairing quality of life.1 Past studies have demonstrated underlying genetic etiology for HS, especially in familial HS, where genetic variation in gamma-secretase complex protein-coding genes accounts for most identified variants from genomewide sequencing in familial and sporadic HS.2 ,3 Nirogacestat, a gamma-secretase inhibitor, was recently approved by the U.S. Food and Drug Administration for the treatment of desmoid tumors. It exerts its effects by blocking Notch signaling through the selective inhibition of gamma-secretase cleavage of Notch receptors.4 We present a rare and intriguing case of a patient who developed HS after 6 months of nirogacestat therapy.  \nTo our knowledge, only 1 other case report has delineated the relationship between gammasecretase inhibitors and the development of HS.  \nCASE  \nA 48-year-old woman presented to our center in November 2024 with a 4-month history of HS-like lesions in her right upper inner thigh that flared  \nFrom the Department of Dermatology, Weill Medical School of Cornell University, New York, New Yorka; SUNY Upstate Norton College of Medicine, Syracuse, New Yorkb; Loyola Stritch School of Medicine, Maywood, Illinoisc; McGovern (University of Texas, Houston) Medical School, Houston, Texasd; and School of  \nMedicine, New York Medical College, Valhalla, New York.e Funding sources: None.  \nPatient consent: Consent for the publication of all patient photographs and medical information was provided by the authors at the time of article submission to the journal, stating that all patients gave consent for their photographs and medical information to be published in print and online, and with the understanding that this information may be publicly available.  \nAbbreviation used:  \nHS: hidradenitis suppurativa  \nmonthly. She began nirogacestat 150 mg twice daily in December of 2023 to treat her right abdominal wall desmoid tumor, first identified in 2021 during her pregnancy. The tumor enlarged peri-and postpartum, and she attempted chemotherapy with Doxil (40 mg/m2) in September of 2023 but terminated the treatment due to infusion reactions. Nirogacestatwas held for 2 months due to a severe rash that developed on January 2, 2024, requiring prednisone, hydroxyzine, and triamcinolone. Nirogacestat was restarted at 50 mg twice daily and escalated back to 150 mg twice daily as of April 8, 2024, increased by 1 tablet every 2 weeks. After 3 months, inflammatory nodules of HS appeared on the right inner thigh. Concomitant side effects included diarrhea, fatigue, amenorrhea, and daily hot flashes consistent with menopause onset. HS remained localized while flares occurred monthly. Acute lesions were refractory to intralesional triamcinolone, Augmentin, and topical therapies. At presentation to our center, HS was clinically diagnosed with 4 to 5 areas of posinflammatory hyperpigmentation and scarring observed in the right inguinal crease and upper medial thigh (Fig 1) . Topical chlorhexidine wash and  \nIRB approval status: Not applicable.  \nCorrespondence to: Steven R. Cohen, MD, MPH, Department of Dermatology, 1305 York Avenue, 9th Floor, New York, NY  \n10021. E-mail: [src4005@med.cornell.edu](src4005@med.cornell.edu). JAAD Case Reports 2026","cbCaiidKvEbx7sz9","https://ap.wps.com/l/cbCaiidKvEbx7sz9","pdf",2475137,"English","# Introduction\n# Case\n# Discussion","[{\"question\":\"What is the reported relationship between nirogacestat and hidradenitis suppurativa in this case?\",\"answer\":\"HS-like lesions emerged after about 6 months of nirogacestat therapy, suggesting a temporal link between gamma-secretase inhibition and HS onset.\"},{\"question\":\"What symptoms occurred alongside the HS flares during nirogacestat treatment?\",\"answer\":\"Concomitant adverse effects included diarrhea, fatigue, amenorrhea, and daily hot flashes consistent with menopause onset.\"},{\"question\":\"How was HS treated after the patient presented to the dermatology center?\",\"answer\":\"HS activity was reduced with topical chlorhexidine wash plus clindamycin gel, together with oral spironolactone and minocycline.\"}]","Androgenic hidradenitis suppurativa onset linked to gamma secretase inhibitor | PDF",1790738223]