Background: Antibiotics are frequently used to treat hidradenitis suppurativa (HS); however, few data on their efficacy are available. Objective: To evaluate the efficacy of a combination of systemic clindamycin (300 mg twice daily) and rifampicin (600 mg daily) in the treatment of patients with severe HS. Methods: Patients (n = 116) who received this combination were studied retrospectively. The main outcome measure was the severity of the disease, assessed by the Sartorius score, before and after 10 weeks of treatment. Results: The Sartorius score dramatically improved at the end of treatment (median = 29, interquartile range = 14.5, vs. median = 14.5, interquartile range = 11; p < 0.001), as did other parameters of severity as well as the quality of life score. Eight patients (6.9%) stopped the treatment because of side effects. Conclusion: The combination of clindamycin and rifampicin is effective in the treatment of severe HS.

We report a significant increase in the number of MI-positive tests. MI is confirmed to be a rapidly emerging allergen, as also observed in other European countries.

In this population of CL patients displaying variable degrees of complexity and severity, almost two-thirds of patients could be initially managed without systemic therapy. Of these, 60 were cured before day 60. The WHO-recommended stepwise approach favoring initial local therapy therefore resulted in at least 44% of all patients being cured without exposure to the risk of systemic adverse events. Efforts are needed to further simplify local therapy of CL and to improve the management of patients with complex lesions and/or preexisting comorbidities.

Our series yielded results similar to those of published series concerning the types of CADR and the drugs responsible. Our results suggest that, for CADRs, if a patient supplies a suspected drug but if the pharmaceutical material and staff are not available for conventional PTs, extemporaneous PTs performed by the nurse with the commercial drug used by the patient can be useful and reliable.

In French patients, testing for EACD with the extended baseline series and personal products, also including ROATs and use tests, appears to be adequate, considering the currently relevant positive test reactions. The regular addition of an eyelid series does not seem to be necessary.

Background Cross‐reactivity among beta‐lactam antibiotics (BL) is essentially reported in immediate hypersensitivity. Objectives To evaluate cross‐reactivity beyond BLs in patients with non‐immediate cutaneous adverse drug reaction (non‐immediate CADR) managed in a dermatology reference centre of toxic bullous and severe CADRs. Patients/Materials/Methods We conducted a retrospective single‐centre study in consecutive patients consulting between 2010 and 2018 with an active BL‐suspected non‐immediate CADR and explored by cutaneous tests [patch tests (PT) and intradermal tests (P‐IDR)] for at least three penicillin's subclasses and amino‐ and non‐amino‐cephalosporins (at least one aminocephalosporin). Cross‐reactivity among subclasses was investigated for patients with positive tests. Results We included 56 patients, among whom 46 amoxicillin‐suspected were and seven cephalosporin‐suspected. Twenty‐nine had severe CADR, and 27 had non‐immediate maculopapular exanthema (MPE). Twenty‐two had positive tests (18 for AS and four for CS). Among the 18 positive amoxicillin‐suspected, 10 (55.6%) showed cross‐reactivity with one or more other BL: 9 (50%) with another penicillin and 3 (16.5%) with a non‐aminocephalosporin. No amoxicillin‐ or cephalosporin‐suspected patient showed cross‐reactivity with aztreonam or carbapenems. P‐IDR showed cross‐reactivity only once. Conclusion After a suspected BL‐induced non‐immediate CADR, a large allergologic exploration is needed to confirm the diagnosis and evaluate cross‐reactivity. In our population including cases of severe CADRs and MPE with late delay of onset, cross‐reactivity was frequent and PT was sufficient to this purpose. The frequent cross‐reactivity among penicillins encourages stopping this whole family and to test cephalosporins, aztreonam and carbapenems for which cross‐allergies are rarer.

DEAR EDITOR, Although they have different biochemical structures, macrolides, lincosamides (including clindamycin) and streptogramins (including pristinamycin) share a similar mechanism of action on Gram-positive bacteria, and are grouped into the MLS family. 1 Cross-allergies induced by drugs of similar mechanism of action but different chemical structure (polysensitivity) are poorly described. Our objectives were to investigate the possibility of polysensitivity among MLS antibiotics, and to compare the value of patch tests (PTs) in MLS-induced delayed cutaneous adverse drug reactions (DCADRs).This retrospective, monocentre study was conducted between 1997 and 2016. We included all patients referred for a DCADR (excluding late urticaria) with any MLS drug suspected, alone or with other culprit drugs, with PTs performed after this DCADR. Cases attributed to another drug by a positive PT and those with a negative rechallenge of the culprit MLS were excluded. PTs for erythromycin, clarithromycin, pristinamycin and clindamycin, diluted at 10% in petrolatum, were supplied by Chemotechnique Diagnostics (Vellinge, Sweden). Those for roxithromycin, azithromycin and spiramycin, diluted to 30% in petrolatum, were prepared by our hospital pharmacy, according to guidelines, and were read after 48 and 96 h. 2 Between 1997 and 2012, PTs involved the suspected drug(s) only. After 2012, all patients underwent complete investigation for all MLS drugs. The following data were obtained from charts: age, sex, type of DCADR, other culprit drugs and PT results. Prior or subsequent intake of any of MLS antibiotic was recorded by phone call to reachable patients.Polysensitivity among MLS antibiotics was investigated by two methods: polysensitivity by PTs (positive PT to at least two MLS antibiotics) and clinical polysensitivity (eruption with another MLS before or after the DCADR investigated by PT). Statistical analyses involved v 2 -test or Fisher test as appropriate. Institutional review board approval was obtained (CLEA-2017-42).Seventy-one patients were included (49 female, median age 55 years, range 24-95); 34 could be contacted by phone. The median time between the DCADR and PTs was 5 months (range 1 month to 11 years). The types of DCADRs and PT results are shown in Table 1.Polysensitivity by PTs was first investigated. Among the 25 patients with complete PT investigation, two (8%) had British Journal of Dermatology (2018) 179, pp978-979 supervised oral challenge is warranted to allow for safe further intake of these commonly used antibiotics, which have few effective and cost-effective alternatives.

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