tetracycline and Hidradenitis-Suppurativa

Although the clinical presentation of Hidradenitis Suppurativa (HS) is strongly reminiscent of bacterial infection, the role of bacteria remains controversial. Studies have isolated an array of different bacterial specimens as well as biofilm formation in lesional HS skin. Consistent findings of Gram-positive cocci and -rods including Staphylococus aureus, Coagulase-negative staphylococci (CoNS) and Corynebacterium species (spp) in deep tissue samples have been demonstrated in HS. Although efficacy of antibiotics, i.e., rifampicin, clindamycin or tetracycline may support a microbial role in disease pathogenesis, the most often isolated bacterial specimens are commensal bacteria (CoNS).

Topics: Anti-Bacterial Agents; Biofilms; Clindamycin; Corynebacterium Infections; Hidradenitis Suppurativa; Humans; Rifampin; Skin; Staphylococcal Skin Infections; Staphylococcus aureus; Staphylococcus epidermidis; Tetracycline

Antibiotics are often used to treat hidradenitis, but only topical clindamycin has been shown to be effective in a randomized controlled trial. The paucity of these trials may be the result of difficulties in disease assessment.. We compare topical clindamycin with systemic tetracycline in the treatment of hidradenitis suppurativa, and study clinical disease assessment.. A total of 46 patients with stage 1 or 2 hidradenitis suppurativa were treated in a double-blind, double dummy controlled trial.. No significant difference was found between the two types of treatment. Patients' global assessment of disease was significantly worse than physician's assessment in 3 of 5 evaluations (P = .0096 to .015), but the correlation between patients' and physicians' assessments was satisfactory after only one visit (rs = .761 to .895). Soreness was the key factor in patients' overall assessment of the disease.. Systemic therapy with tetracyclines did not show better results than topical therapy with clindamycin. Subjective factors, particularly soreness, appear to be a key factor in patients' assessment of the disease and should, therefore, be included as an outcome variable in future therapy studies.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Clindamycin; Double-Blind Method; Female; Hidradenitis Suppurativa; Humans; Male; Tetracycline; Treatment Outcome

Hidradenitis suppurativa (HS) rarely affects pediatric patients. The literature on pediatric HS patients is scarce. This is a cross-sectional study based on case note review or interviews and clinical examination of 140 pediatric patients undergoing secondary or tertiary level care. Patients were predominantly female (75.5%, n = 105) with a median age of 16. 39% reported 1st-degree relative with HS. Median BMI percentile was 88, and 11% were smokers (n = 15). Median modified Sartorius score was 8.5. Notable comorbidities found were acne (32.8%, n = 45), hirsutism (19.3%, n = 27), and pilonidal cysts (16.4%, n = 23). Resorcinol (n = 27) and clindamycin (n = 25) were the most frequently used topical treatments. Patients were treated with tetracycline (n = 32), or oral clindamycin and rifampicin in combination (n = 29). Surgical excision was performed in 18 patients, deroofing in five and incision in seven patients. Obesity seemed to be prominent in the pediatric population and correlated to parent BMI, suggesting a potential for preventive measures for the family. Disease management appeared to be similar to that of adult HS, bearing in mind that the younger the patient, the milder the disease in majority of cases.

Topics: Acne Vulgaris; Administration, Cutaneous; Administration, Oral; Adolescent; Anti-Bacterial Agents; Body Mass Index; Child; Clindamycin; Comorbidity; Cross-Sectional Studies; Dermatologic Surgical Procedures; Drug Therapy, Combination; Female; Hidradenitis Suppurativa; Hirsutism; Humans; Male; Obesity; Pilonidal Sinus; Resorcinols; Rifampin; Risk Factors; Severity of Illness Index; Smoking; Tetracycline; Treatment Outcome; Young Adult

An aberrant interaction between commensal skin bacteria and the host skin immune system is considered important in the pathogenesis of hidradenitis suppurativa (HS).. In this study, we investigated the antibiotic susceptibility and biofilm-forming capabilities of S. epidermidis strains isolated from HS patients.. Skin biopsies were taken from active HS lesions such as inflammatory nodules and/or sinuses and non-involved skin from 26 patients and cultured under optimal microbiological conditions for 24 h. Planktonic growth, biofilm production, antibiotic susceptibility and biofilm eradication by clindamycin, doxycycline, rifampicin and tetracycline were tested including a laboratory control strain of S. epidermidis for reference.. Staphylococcus epidermidis was cultured in 16 of 26 HS patients (62%). In total 27 different S. epidermidis isolates were identified; 16 (59%) from non-involved skin and 11 (41%) from HS lesions. All bacterial strains showed planktonic growth. Twenty-four of 27 (89%) isolates were strong biofilm producers in vitro. The biofilm-forming capability varied amongst the strains from non-involved skin and lesional skin. Twenty-four strains had an intermediate to resistant antibiotic susceptibility to clindamycin (89%). Rifampicin was the most effective antibiotic at inhibiting planktonic growth and at eradication of biofilm (P < 0.05).. We observed a slight increase in S. epidermidis virulence, characterized by resistance to commonly used antibiotics, increased biofilm production and resistance to biofilm eradication. In particular, the reduced sensitivity to tetracycline and clindamycin, two standard antibiotics in the treatment of HS, is alarming. Rifampicin, also important in HS treatment, showed the greatest efficacy at eradicating the biofilm at low MIC concentrations.

Topics: Anti-Bacterial Agents; Biofilms; Clindamycin; Doxycycline; Drug Resistance, Bacterial; Hidradenitis Suppurativa; Humans; Microbial Sensitivity Tests; Rifampin; Staphylococcus epidermidis; Tetracycline