Topical Antibiotics For Hidradenitis Suppurativa
OverviewAntibiotics are medications that kill or inhibit the growth of microorganisms such as bacteria or fungi. Antibiotics work by attacking the source of the infection. In cases of hidradenitis suppurativa , oral antibiotics may work by reducing the bacterial load on the skin. Some antibiotics are also anti-inflammatory agents. Topical antibiotics have a localized effect, meaning they work only on the areas to which they are applied. Most side effects are usually confined to the local area, as well.
There are several different classes of antibiotics, each of which works in a slightly different way. Topical Clindamycin is often the first treatment prescribed for mild hidradenitis suppurativa .
How do I take it?Topical antibiotics are applied to the skin as cream, gel, ointment, or solution. Always use medications exactly as prescribed by the doctor.
Side effectsSome classes of antibiotics can cause more or worse side effects than others. Side effects often increase at higher dosages. Common side effects of topical Clindamycin include redness, dry skin, itching, burning, peeling, oily skin, abdominal pain, and stomach upset.
Rarely, topical Clindamycin can cause serious side effects including allergic reactions, eye pain, and folliculitis .
For more details about this treatment, visit:
Oral Treatments for Hidradenitis Suppurativa Hidradenitis Suppurativa Foundation, Inc.
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What Are The Possible Side Effects Of Antibiotics
Side effects can vary depending on the specific drug you are taking. Common side effects of antibiotics include:3
- Diarrhea, nausea, or vomiting
- Yeast infections
In some cases, some antibiotics can cause serious side effects, including:3-7
- C. diff infections, which causes diarrhea that can lead to severe damage to the colon and death
- Severe and life-threatening allergic reactions
- Kidney and liver problems
These are not all the possible side effects of antibiotics. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking antibiotics.
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What Is Hs Again
While doctors still dont understand what causes the painful, recurrent lesions to form, the best guess at the moment is that there seems to be some kind of defect in the hair follicles on your body. In HS, inflammation develops around follicles and causes them to eventually break open. This releases the hair shaft and normal bacteria from the follicle under the skin, which leads to more inflammation. For some reasonmaybe because of faulty genes or some type of environmental trigger like hormones or chemicalsyour immune system gets reprogrammed to attack these ordinarily friendly bacteria. The resulting inflammation makes it easier for bacteria to proliferate, which causes more inflammation and pus-filled nodules that look like boils.
Left to run their course, these nodules grow, swell, and burst over the span of a week or two, spilling foul-smelling blood and pus from deep in the skin, staining your clothes. All you know is that these lesions hurt like heck and take a long time to heal. In mild cases, or early in the disease, people tend to have solitary nodules mainly in one area. Stage 1 is nodules coming and going without scar or tunneling. Stage 2 is when the presence of one or a few widely separated tunnels in one or multiple body areas, and 3 widespread and/or interconnected tunnels or scarring in one or multiple body regions. Stage 1 can be in multiple body areas, and stage 3 can be in only one body area.
Antibiotics Used To Treat Hidradenitis Suppurativa
Antibiotics for HS may be applied topically or administered orally. Topical antibiotics work locally , while oral antibiotics work systemically . Some of the most commonly prescribed oral antibiotics for HS include:
- Skin symptoms including redness, drying, itchiness, burning, peeling, and oiliness
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Examples Of Antibiotics For Hs
HS does not have 1 best antibiotic treatment. Your doctor will prescribe antibiotics based on the severity of your condition and your needs.1,4
The most commonly prescribed antibiotics for HS include:1,4-6
- Clindamycin combined with rifampin
Other antibiotics benefit some people with HS, but more research is needed to support recommendations.7,8
Course And Burden Of Disease
HS is a chronic relapsing disease. If not treated adequately it may lead to serious complications such as bacterial infections, fistula formation, contractures and limb mobility limitations, squamous cell carcinoma, depression, anemia, malaise, and social impairment . Indeed, it has been reported to prevent patients from working during disease flares , and the purulent discharge can produce an odor and stain clothing, resulting in social stigma . Scarring can also cause considerable disability . A recent study showed that the effect of HS on the Dermatology Life Quality Index was 5.77 ± 4.59 for patients with Hurley stage I disease, 13.1 ± 6.41 for patients with Hurley II, and 20.4 ± 6.67 for patients with Hurley III. This is very high compared to a wide spectrum of other dermatological diseases . For example, moderate to severe psoriasis has a mean DLQI reported at 12-13 .
Among patient-reported signs and symptoms, pain was reported by 85% of individuals with HS to be the most bothersome, followed by swelling/inflammation and sensitivity/tenderness .
Hidradenitis Suppurativa: Diagnosis And Treatment
A dermatologist is often the doctor who diagnoses a patient with hidradenitis suppurativa
Getting an accurate diagnosis and an individualized treatment plan can prevent HS from worsening.
Hidradenitis suppurativa can look like another skin condition, such as worsening acne, boils, or herpes. Dermatologists have the training needed to spot the differences between HS and other conditions. This unique training allows them to diagnose HS more quickly.
Heres what you can expect when you see a dermatologist.
Classes Of Hidradenitis Suppurativa Drugs
Doctors use many different classes of drugs to treat HS. For several of these classes, there are a variety of drug agents within them.
The classes of HS drugs include:
Antibiotics are a mainstay of HS treatment. If your doctor diagnoses HS, you will likely start with an antibiotic. Skin care and lifestyle changes, such as losing weight, may also help some people. However, everyone responds to treatment differently. It may be necessary to add other classes of drugs to control HS. Doctors usually reserve biologics for HS resistant to first-line drugs like antibiotics.
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What Are The Symptoms Of Hidradenitis Suppurativa
The characteristic symptoms of these skin conditions are as follows
- Blackheads: It starts with small pitted areas of the skin containing blackheads. It may appear in several body locations such as the groin, pubic region, buttocks, armpits and under the breast and may return often.
- Painful lumps: It always starts with a single, painful small lump under the skin that persists for weeks or months. Later, you may have more bumps. They usually appear in body areas with hair follicles that are more prone to sweating such as the groin and armpits. It may also appear in areas where the skin rubs together, such as skin folds under the breast, buttocks and inner thighs.
- Tunnels: Over time, tunnels connecting the two lumps may form under the skin. They dont improve in a few weeks, but heal very slowly and often flare. They can leak very smelly pus.
Some may experience only mild symptoms. The severity of this skin condition will be assessed by your doctor in three stages
- Stage I: Solitary or multiple isolated abscess without the formation of any tunnel or scarring.
- Stage II: Recurrence of pus-filled lump, single or multiple widely spaced lesions with the formation of tunneling in the wound.
- Stage III: A wide and large spread of pus-filled lumps with multiple tunnels in the wound.
Local Therapy And Wound Care
Local treatment of this chronic disorder includes antiseptic washes, keratolytic agents and topical antibiotics . Selection of dressing is based on the location, skin condition, amount of drainage, cost and patient preference . For local treatment of selected large open wounds, use of negative-pressure therapy for a short period of time followed by delayed reconstruction might be effective . Clinical experience supported the use of Intralesional corticosteroid injection only for short-term control of acute and recalcitrant HS lesions . Pain is typically reduced fast and a reduction in edema, erythema, suppuration and lesion size occur after a few days. However, the long-term efficacy of this approach remains unclear and local side effects, most notably skin atrophy, have to be carefully monitored .
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What Causes Hidradenitis Suppurativa
The exact cause of hidradenitis suppurativa is unknown, but the lumps develop as a result of blocked hair follicles.
Hidradenitis suppurativa usually starts around puberty, but it can occur at any age. It’s less common before puberty and after the menopause, which may suggest that sex hormones play a part. Many people with the condition also have acne and excessive hair growth .
In rare cases, hidradenitis suppurativa may be linked to Crohn’s disease, particularly if it develops around the groin area and the skin near the anus. Crohn’s disease is a long-term condition that causes the lining of the digestive system to become inflamed.
Hidradenitis suppurativa runs in families in about 1 in 3 cases. It’s not infectious and isn’t linked to poor hygiene.
Risk Factors And Comorbidities
Among all risk factors for HS studied to date, the strongest correlation among biological factors is obesity, while the strongest environmental association is with smoking. Revuz et al. found an odds ratio of 4.42 for obesity and 12.55 for smoking compared to healthy controls. Another study by Miller et al. found an OR of 6.38 for obesity. In line with this, individuals with diabetes mellitus and metabolic syndrome also have a strong positive association with HS . Individuals with HS also suffer from a significantly higher rate of cardiovascular risk factors compared to healthy controls .
With respect to disease progression, 5 risk factors were associated with an increased risk of progression from Hurley stage I to stage II or III in a retrospective study of 846 Dutch individuals with HS. These included male gender, disease duration, BMI, smoking pack-years, and lesion location .
In addition, mechanical irritation and friction may also trigger HS , and the co-occurrence of HS with polycystic ovary syndrome, Crohn disease , and depression is statistically significant .
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Clindamycin Combined With Rifampin For Hs
Clindamycin and rifampin are often used to treat inflammation. They are oral antibiotics that are used together to treat severe HS symptoms. They are also used when a tetracycline antibiotic does not work in people with mild to moderate HS.2,7,8
Researchers have studied treatment with this combination more than most other antibiotics. Using this treatment for 10 weeks, studies have shown that the combination reduces disease. Some people with HS had complete remission.2,7,8
Suggested Therapy Approach Based On The Current Knowledge
There is no single efficient therapy for the skin disorder. As a result, clinicians typically should choose from different treatment modalities and often have to combine them to achieve disease control. The choice of treatment depends on the distribution and overall severity of disease, the anatomic location and inflammatory activity of the lesions, the patient’s comorbidities, as well as treatment cost and availability . In order to assess the severity and extent of hidradenitis suppurativa various scoring systems are in common use: hurley stages, sartorius hidradenitis suppurativa score, hidradenitis suppurativa physician global assessment and hidradenitis suppurativa clinical response .
HS management is often complex. The standard of care management requires an individualized approach in a multifaceted approach, ranging from self-management to local therapies, systemic antibiotics, and a wide range of immunomodulating agents, as well as surgical interventions such as excisional and laser surgeries . Additionally, the diagnosis and management of medical comorbidities and referral to psychiatrist might be taken into consideration . An overview of a suggested multidimensional approach is summarized in Figure 1.
Figure 1. Clinical practice recommendations for the treatment of HS, modified from Hunger et al. and Saunte and Jemec .
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Hormonal Therapies For Hs
Research shows that androgens affect HS in women, as shown by changes related to pregnancy and menstrual cycles. Hormonal therapies include:4,16,17
- Estrogen-containing birth control pills Showed improvement in a rigorous test
- Anti-androgen therapies Showed improvement block effects of androgen
- Metformin Drug that treats type 2 diabetes notable improvement mostly in women with polycystic ovarian syndrome
- Finasteride Drug that treats enlargement of the prostate gland in men helpful in limited research
- Spironolactone Drug that treats high blood pressure helpful in limited research
How Antibiotics Can Help Treat Hidradenitis Suppurativa
While hidradenitis suppurativa is not caused by infection, the use of antibiotics is common in its treatment. In addition to their antibacterial activity, many antibiotics commonly prescribed for HS are known to have anti-inflammatory effects. This means they act on the immune system to reduce inflammation. Antibiotics may be effective in helping to decrease bacteria living on the skins surface, treat infected lesions, heal them, and prevent new ones from forming.
Dermatologists often prescribe antibiotics for lesions that may be infected, but also to reduce the number and types of bacteria on the skin that can result in inflammation. Usually, topical antibiotics are prescribed for mild cases of HS, while oral antibiotics are prescribed for moderate to severe HS.
The perceived effectiveness of antibiotics in treating HS may be disguised by the natural duration of its symptoms: A study of 110 people with HS revealed the average duration of painful nodules to be 6.9 days, which is about as long as an average course of antibiotics.
As I’ve gotten more sophisticated in my approach, I use them less and less, Dr. Kimball noted. When she does prescribe antibiotics, it is typically for an HS flare. They certainly have benefits, but for lots of people, they are not going to be enough.
Dr. Kimball explained that she leans towards hormonal treatments, like oral contraceptives or Aldactone , rather than antibiotics for medium- and long-term treatment.
What Is The Best Treatment For Hs
It depends. Doctors try a combination of medical treatments and sometimes surgery depending on the type of nodules you have, how severe they are, and where they’re cropping up on your bodywith the understanding that what works for one person may not work for you. Whats more, HS doesnt just affect your skin. Its an inflammatory condition, which means there are a wide range of illnesses that often occur with it like inflammatory bowel disease spondyloarthritis , a form of arthritis that causes back pain anxiety and depression and metabolic syndrome, a cluster of risk factors that include obesity, high blood pressure, and high cholesterol that ups your risk of diabetes, strokes, and heart disease. Thats why its important to get a whole team of pros that can help you get everything under controlyour body, skin, and soul.
Members Of Myhsteam On Hidradenitis Suppurativa Antibiotics
Many myHSteam members have shared their experiences with taking antibiotics:
- I have tried all antibiotics, and nothing worked. I am currently taking Humira, and its slowly taking effect. I wish they could find something that works straight away.
- Just returned to treatment with Humira and antibiotics. Flare-ups are getting under control.
- Ive been on so many antibiotics for HS that I have become resistant.
- My doctor says Im really resistant to antibiotics. Not sure what to do.
- I have had HS for over 40 years. Antibiotics are only good for infection, and most HS lesions are not infected.
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Hidradenitis Suppurativa Skin Care Routine
Even with medication and physician-driven treatment plans, HS may be challenging to manage. Talk with your doctor about implementing a skin care routine, such as the following:
- Keep your skin cool. You will want to avoid overheating since it can exacerbate the symptoms.
- Use an antiseptic cleanser. An antiseptic or antimicrobial wash may help limit flare-ups.
- Try over-the-counter acne treatments. You can buy benzoyl peroxide face washes at your local grocery and drug store that may help.
- Avoid ointments and thick creams. You want to avoid plugging your hair follicles since it can aggravate HS over time.
- Shave or wax the hair around affected areas.
- Try to preventexcessivesweating. Excessive perspiration can trigger flare-ups. Try methods such as limiting tight clothes and synthetic fabrics, and limiting things that may increase sweating like spicy foods and alcohol.
Research indicates a link between smoking cigarettes and living with obesity to more severe HS disease progression. Practicing lifestyle modifications such as quitting smoking if you smoke and maintaining a moderate weight may help you better manage your symptoms.
Additionally, some activities may further irritate your skin. You may find it helpful to avoid doing the following things at or around the affected area:
- wearing tight or restrictive clothing
- cleaning with harsh tools, such as brushes or washcloths
- using adhesive bandages
- using products that may contain irritants, such as detergents or perfumes