Lymecycline vs. clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasonography evaluation

Abstract

Background. Antibiotic therapy remains the first-line treatment for hidradenitis suppurativa (HS). However, literature data on its comparative clinical efficacy and safety are limited. Aim. To investigate the efficacy of tetracycline (lymecycline 300 mg daily) vs. the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily) by evaluating and comparing the clinical response at the end of antibiotic treatment (10 weeks). Methods. The study retrospectively analysed 52 patients divided in two groups of 26 patients: Group A received lymecycline and Group B received clindamycin plus rifampicin for 10 weeks. Subjects had mild, moderate and severe HS. The clinical and ultrasonography extent of disease was measured by the Hurley Score, Sonographic Score of Hidradenitis Suppurativa, International Hidradenitis Suppurativa Severity Score System (IHS4), pain visual analogue scale (pain VAS) and Dermatology Life Quality Index (DLQI). The primary outcome was the clinical response at the end of the antibiotic treatment period, according to the Hidradenitis Suppurativa Clinical Response measure. Results. Both groups showed a significant improvement in IHS4, pain VAS and DLQI from baseline, but this was more marked in Group A. Reductions in nodule counts were similar between the two groups, whereas the number of abscesses and draining tunnels decreased more in Group B. Disease-free survival was similar between the two groups. Conclusion. Lymecycline monotherapy and clindamycin plus rifampicin combination are both effective treatments for patients with moderate-severe HS. Nodulartype HS seems to respond better to lymecycline, whereas the abscess/tunnel type seems to respond better to clindamycin plus rifampicin.

Quality of Life in Hidradenitis Suppurativa: An Update

“…HRQoL, assessed by the DLQI, improved more in patients treated with clindamycin than in the patients treated with clindamycin plus rifampicin [ 58 ]. ‘More marked’ HRQoL improvement, as measured by the DLQI, occurred in patients treated with tetracycline alone compared to patients treated with a combination of clindamycin and rifampicin [ 59 ].…”

Real‐world effectiveness of adalimumab in patients with moderate‐to‐severe hidradenitis suppurativa: the 1‐year SOLACE study

“…Whereas the Hurley clinical grading system is commonly used for screening and grading severity of HS, 2 the IHS4 – recognized as simple to use and adapted for clinical research and daily practice 6 – has been validated and reported in several clinical studies for assessing HS response 8,17,20‐23 . To our knowledge, SOLACE is the first study reporting changes in IHS4 scores observed by baseline AN count.…”

Clinical and Power‐Doppler ultrasound features related with persistence of fistulous tracts under treatment with adalimumab in hidradenitis suppurativa: 4 years of follow‐up

“…1 It is known from literature that fistulas are poorly responsive to the currently available medical treatments. 6,[9][10][11][12][13][14] At the same time,…”

“…1 It is known from literature that fistulas are poorly responsive to the currently available medical treatments. 6,[9][10][11][12][13][14] At the same time, these lesions play a central role in the "window of opportunity" acting as a sort of watershed between medical and surgical approach. 6 Therefore, the analysis of their features related to their clinicalsonographic response may indicate when the medical therapy alone might be still effective.…”