Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: Clinical and ultrasound observations

Clindamycin alone may be enough. Is it time to abandon rifampicin for hidradenitis suppurativa?

“…Moreover, we recently outlined the role of clindamycin as effective monotherapy in HS . In particular, our result showed a higher efficacy of clindamycin alone on draining tunnels and a similar response of clindamycin monotherapy on nodules and abscesses compared with combined therapy …”

“…The combined clindamycin plus rifampicin protocol is generally the first‐line treatment for moderate‐to‐severe HS; however, two recent studies claimed that rifampicin significantly decreases the concentration of clindamycin . Moreover, we recently outlined the role of clindamycin as effective monotherapy in HS . In particular, our result showed a higher efficacy of clindamycin alone on draining tunnels and a similar response of clindamycin monotherapy on nodules and abscesses compared with combined therapy …”

“…regarding the possible use of rifampicin monotherapy in patients with hidradenitis suppurativa (HS). The combined clindamycin plus rifampicin protocol is generally the first‐line treatment for moderate‐to‐severe HS; however, two recent studies claimed that rifampicin significantly decreases the concentration of clindamycin . Moreover, we recently outlined the role of clindamycin as effective monotherapy in HS .…”

“…We speculated that the lower clindamycin concentration due to the inhibitory effect of rifampicin could reduce the strength of the treatment itself in severe HS lesions such as the draining tunnels, which are often colonized by polymorph‐abundant anaerobic microflora . In fact, anaerobes were recovered from 95% and 100% of Hurley stage II and III lesions, respectively, compared with 54% of Hurley stage I nodules and abscesses .…”

Ultrasonography in the pathway to an optimal standard of care of hidradenitis suppurativa: the Italian Ultrasound Working Group experience

“…More recently, a consensus of international experts validated five key lesions detectable by US: pseudocyst, fluid collection, fistulous tract, connected fistulous tracts and hair tracts, and recommended the routine use of the colour Doppler function during US examination . Doppler activity in the elementary lesions indicates the presence of inflammation that may be crucial in choosing the correct therapeutic approach …”