Original article
The efficacy and tolerability of tetracyclines and clindamycin plus rifampicin for the treatment of hidradenitis suppurativa: Results of a prospective European cohort study

https://doi.org/10.1016/j.jaad.2020.12.089Get rights and content
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Background

Tetracyclines and clindamycin plus rifampicin combination therapy are both considered first-line therapy in current hidradenitis suppurativa guidelines. However, evidence for their efficacy is drawn from small studies, often without validated outcomes.

Objective

To assess the 12-week efficacy of oral tetracyclines and a combination of clindamycin and rifampicin.

Methods

A prospective, international cohort study performed between October 2018 and August 2019.

Results

In total, 63.6% of the included 283 patients received oral tetracyclines, and 36.4% were treated with clindamycin and rifampicin. Both groups showed a significant decrease in International Hidradenitis Suppurativa Severity Score System from baseline (both P < .001). The Hidradenitis Suppurativa Clinical Response (HiSCR) was achieved in 40.1% and 48.2% of patients, respectively (P = .26). Patient characteristics or disease severity were not associated with the attainment of HiSCR or the minimal clinically important differences for the Dermatology Life Quality Index and pain.

Limitations

Cohort study. Respectively, 23.9% and 19.4% of patients had to be excluded from the HiSCR analysis for the tetracycline and combination therapy group because of a low abscess and nodule count at baseline.

Conclusion

This study shows significant efficacy of both tetracycline treatment and clindamycin and rifampicin combination therapy after 12 weeks in patients with hidradenitis suppurativa. No significant differences in efficacy were observed between the 2 treatments, regardless of disease severity.

Key words

acne inversa
antibiotics
clindamycin
doxycycline
efficacy
guideline
minocycline
outcome
rifampicin
tetracycline
therapy
treatment

Abbreviations used

BMI
body mass index
CI
confidence interval
DLQI
Dermatology Life Quality Index
HiSCR
Hidradenitis Suppurativa Clinical Response
HS
hidradenitis suppurativa
IHS4
International Hidradenitis Suppurativa Severity Score System
MCID
minimal clinical important difference
NRS
Numerical Rating Scale
OR
odds ratio
PROM
patient-reported outcome measure

Cited by (0)

Drs van Straalen and Tzellos contributed equally to this article.

Funding sources: None.

IRB approval status: The study was performed within daily practice and in accordance with current guidelines; therefore, it was deemed exempt from IRB review.

Reprints not available from the authors.