Clindamycin Monotherapy May Be Superior to Dual Therapy for Hidradenitis Suppurativa

Hidradenitis suppurativa
Hidradenitis suppurativa
Clindamycin as monotherapy may be a useful and safe alternative to combination clindamycin and rifampicin treatment for hidradenitis suppurativa.

Clindamycin monotherapy may be as or more effective than dual antibiotic treatment for hidradenitis suppurativa (HS) regardless of clinical stage, according to research published in the Journal of the American Academy of Dermatology.

A cohort (N=60) of men and women ≥18 years of age with clinical and sonographic criteria of HS and total abscesses and inflammatory nodule ≥3 at baseline were divided into 2 treatment groups. For a total of 8 weeks, Group A (n=30) was treated with oral clindamycin 150 mg 4 times daily and oral rifampicin 300 mg twice daily; Group B (n=30) was treated with oral clindamycin 150 mg 4 times daily. Researchers performed Power Doppler ultrasound (PD-US) examinations on all patients at baseline and at week 8. The Pulse Repetition Frequency, the Time Gain Compensation, and the Volumetric Image Acquisition were kept constant to reduce PD-US observation limits and statistical mistakes. Researchers analyzed the lesional type of involvement (nodule, abscess, draining tunnel), lesion location, maximum diameter (mm) of the lesion, draining tunnel’s thickness, and presence of vascularization from the sonographic data.

Statistical analysis showed equivalence between the mono and combination therapy groups, with a significant improvement in disease activity found in both groups (P =.598) as assessed by Hidradenitis Suppurativa Clinical Response, International Hidradenitis Suppurativa Severity Score System, PD-US, Pain Visual Analogue Scale, and Dermatology Life Quality Index. Group B had a significantly greater decrease in Pain Visual Analogue Scale (P =.038) and Dermatology Life Quality Index (P =.037) compared with Group A. The count reduction of nodules (P =.517) and of abscesses (P =.938) was not statistically different between the groups. The number of reduced draining tunnels “was statistically more elevated in Group B than in Group A (P =.002),” the researchers noted.

The investigators speculated that “consequent lower clindamycin levels in combined protocols may reduce the strength of the treatment itself in severe HS lesion, as draining tunnels are commonly colonized by polymorph-abundant anaerobic microflora.” The fact that this study was not randomized or placebo-controlled contributes to limitations of the findings.

The researchers concluded that clindamycin as monotherapy may be a useful and safe alternative to combination clindamycin and rifampicin treatment but suggest that “[p]rospective randomized controlled trials are needed to confirm the results of this study.”

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Caposiena Caro RD, Cannizzaro MV, Botti E, et al. Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasound observations [published online November 28, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.11.035