Antibiotics in hidradenitis suppurativa

Antibiotics still play an important role in hidradenitis suppurativa (HS). Overuse or arbitrary use should be avoided, stated Dr Dunja Ana Vekic (University of New South Wales, Australia).

Although HS is not primarily an infectious disease, bacteria contribute to the inflammatory drive [1]. The microbiome of healthy skin and HS is different and bacterial biofilms possibly play a role in chronic HS [1-3]. Various guidelines suggest antibiotics in mild-to-moderate HS and also for acute lesions of all stages [1,4, 5]. Currently, clindamycin 1% is the only recommended topical therapy for mild disease as it demonstrated benefit over placebo [1,4,6]. Oral antibiotics should be given for Hurley stages 2 and 3 and non-responders to topical antibiotics [1]. Approved agents for monotherapy are tetracycline, minocycline, and the most commonly prescribed doxycycline [1,5]. Combination therapy is recommended with clindamycin plus rifampicin [1].

Concerns for antibiotic therapy include substantial resistance rates, overuse or arbitrary treatment duration, adverse events influencing compliance, and lack of randomised controlled trials [1,7]. “The future management of HS will probably be moving from antibiotic therapy to a more personalised treatment and immunotherapy,” was the opinion of Dr Vekic.

1. 
   
   1. Vekic DA. 24th World Congress of Dermatology, 10-15 June 2019, Milan, Italy.
   2. Stoodley P. Br J Dermatol 2017;176:855-856.
   3. Ring HC, et al. Br J Dermatol 2017;176:993-1000.
   4. Zouboulis CC, et al. J Eur Acad Dermatol Venereol. 2015;29: 619-44.
   5. Vekic DA, et al. Australas J Dermatol 2018;59:261-266.
   6. Alikhan A, et al. J Am Acad Dermatol. 2019;81:91-101.
   7. Woodruff CM, et al. Mayo Clin Proc. 2015;90:1679-93.

Posted on 26 August, 201928 March, 2024