Lymecycline versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasound evaluation.

BACKGROUND Antibiotic therapy remains the first-line treatment for hidradenitis suppurativa (HS). However, literature data on comparative clinical efficacy and safety are limited. AIM To investigate the efficacy of tetracycline (lymecycline 300 mg daily) versus the combination therapy clindamycin and rifampicin (600 mg plus 600 mg daily). METHODS The study retrospectively analyzed 52 patients divided in two groups of 26 patients receiving lymecycline (group A) and clindamycin plus rifampicin (group B) for 10 weeks. Subjects had mild, moderate and severe HS. The clinical and ultrasonography extent of disease was measured with Hurley scoring, Sonographic Score of Hidradenitis Suppurativa (SOS-HS), International Hidradenitis Suppurativa Severity Score System (IHS4), pain Visual Analogue Scale (pain-VAS), and Dermatology Life Quality Index (DLQI). The primary outcome was to evaluate and compare the clinical response at the end of antibiotic treatment (10 weeks) between the two groups, according to the Hidradenitis Suppurativa Clinical Response measure (HiSCR). RESULT Both groups showed a significant improvement in IHS4, pain VAS and DLQI from baseline, particularly group A. The reductions in nodule counts were similar between the two groups, whereas the number of abscess and draining tunnels decreased more in group B. Disease free survival was similar between the two groups. CONCLUSIONS Lymecycline and clindamycin plus rifampicin are both effective treatments of moderate-severe patients with HS. "Nodular" type HS seems to respond better to lymecycline, but predominantly "abscesses-tunnel" type to clindamycin plus rifampicin.