Recurrent perianal abscess/fistula

My immune system has been very active lately. I keep having perianal abscesses and have had 3 since the beginning of this year. Given that I have long-standing Crohn's and started to have numerous abscesses that were not only perianal but also vaginal, dermatologists and CR surgeons insisted they were caused by HS. Had to take many rounds of antibiotics especially Clindamycin and other antibiotics for skin disorders and things are getting worse. My GI suspected that the abscesses were not HS related. So, he asked the radiologist to revise all my previous scans and he confirmed that they were all Crohn's related and that I have a perianal abscess/ fistula. I'm on Rinvoq 30 mg and though the colonoscopy I had had end of December 2023 showed that my Crohn's is under control, it seems it is not controlling the recurrence of the same abscess/fistula I've had for years. I discussed with my GI the possibility of changing Rinvoq or even combining it with another biologic but the answer is always that I had an allergic reaction to Remicade so I am expected to have the same reaction with Humira. As for Stelara, I didn't respond to it and the same is expected with Skyrizi. I'm at wits end. Hope somenone could fill me in with their success experiences with other biologics though I've exhausted them all and I don't think I have anything else left that would control the activity of these recurrent abscesses/fistulas.

Thank you, Tom. Well, I haven’t discussed with my GI his future plans yet. The tenesmus turned out to be fecal impaction and I had to see a CR surgeon. He prescribed a compounded laxative and fleet enemas. I contacted my GI to take his approval of the medication and he informed me that my chronic abscess/fistula is Crohn’s related and not HS.

Hi Randy
HS is an abbreviation of Hidradenitis Suppurativa. It’s a dermatological autoimmune disease that appears like infected boils in the armpit, vulva, perianal, perineal and other places. There are stages for it. The initial treatment is antibiotics but a lot of people take biologics. The FDA approved biologics are Humira and Consentyx. It can come hand in hand with Crohn’s; that’s why, dermatologists jumped to the diagnosis that I have it since I have Crohn’s.