Combination Treatment for Hidradenitis Suppurativa

Main Article Content

Niyaz Mostafa
Kevin Phan
Anousha Yazdabadi

Keywords

hidradenitis, combination, hidradenitis suppurativa

Abstract

Background: The treatment of hidradenitis suppurativa remains challenging, despite recent advances. A diverse range of management options, from lifestyle measures to monoclonal antibodies, are available and utilized based on disease severity and other patient factors. Increasingly, it is thought that combination therapy may be more adept in meeting the challenges of treatment of this multimodal disorder.


Methods: A literature review of existing studies was performed. Eligible studies for the present review included case reports, case series, cohort studies or clinical trials in which patients with hidradenitis suppurativa were treated with a combination of two or more medical treatments. Abstracts, conference presentations, editorials, reviews, and expert opinions were excluded from analysis.


Results: A total of 19 studies were identified from systematic database searches after applying inclusion and exclusion criteria. The majority of treatments documented are systemic antibiotic combinations, however a minority relate to topical and biological agents. The treatment combinations  had varying degrees of efficacy.


Conclusion: There is evidence that combination therapy is effective in the treatment of hidradenitis suppurativa. However the data is limited, and further, more robust, prospective studies with larger cohorts are required to reaffirm the findings in the present review.

References

1. Phan K, Charlton O, Smith SD. Global prevalence of hidradenitis suppurativa and geographical variation—systematic review and meta-analysis. Biomed Dermatol. 2020;4:2.

2. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105–115.

3. Kurzen H, Kurokawa I, Jemec GBE, et al. What causes hidradenitis suppurativa? Exp Dermatol. 2008;17:455–456; discussion 457-472.

4. Prens E, Deckers I. Pathophysiology of hidradenitis suppurativa: An update. J Am Acad Dermatol. 2015;73:S8-11.

5. Nesbitt E, Clements S, Driscoll M. A concise clinician’s guide to therapy for hidradenitis suppurativa. Int J Womens Dermatol. 2019;6:80–84.

6. Frew JW, Hawkes JE, Krueger JG. Topical, systemic and biologic therapies in hidradenitis suppurativa: pathogenic insights by examining therapeutic mechanisms. Ther Adv Chronic Dis. 2019;10:2040622319830646.

7. National Health and Medical Research Council (NHMRC). NHMRC Additional Levels of Evidence and Grades for Recommendations for Developers of Guidelines. Melbourne, VIC, Australia: NHMRC; 2009.

8. Bettoli V, Zauli S, Borghi A, et al. Oral clindamycin and rifampicin in the treatment of hidradenitis suppurativa-acne inversa: a prospective study on 23 patients. J Eur Acad Dermatol Venereol JEADV. 2014;28:125–126.

9. Ochi H, Tan LC, Oon HH. The effect of oral clindamycin and rifampicin combination therapy in patients with hidradenitis suppurativa in Singapore. Clin Cosmet Investig Dermatol. 2018;11:37–39.

10. Mendonça CO, Griffiths CEM. Clindamycin and rifampicin combination therapy for hidradenitis suppurativa. Br J Dermatol. 2006;154:977–978.

11. Marasca C, Annunziata MC, Villani A, et al. Adalimumab versus Rifampicin Plus Clindamycin for the Treatment of Moderate to Severe Hidradenitis Suppurativa: A Retrospective Study. J Drugs Dermatol JDD. 2019;18:437–438.

12. Gener G, Canoui-Poitrine F, Revuz JE, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatol Basel Switz. 2009;219:148–154.

13. Caro RDC, Cannizzaro MV, Botti E, et al. Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: Clinical and ultrasound observations. J Am Acad Dermatol. 2019;80:1314–1321.

14. Dessinioti C, Zisimou C, Tzanetakou V, et al. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up. Clin Exp Dermatol. 2016;41:852–857.

15. van der Zee HH, Boer J, Prens EP, et al. The effect of combined treatment with oral clindamycin and oral rifampicin in patients with hidradenitis suppurativa. Dermatol Basel Switz. 2009;219:143–147.

16. Caro RDC, Molinelli E, Brisigotti V, et al. Lymecycline vs. clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasonography evaluation. Clin Exp Dermatol [Internet]. [cited 2020 Oct 17];n/a. Available from: http://onlinelibrary.wiley.com/doi/abs/10.1111/ced.14388.

17. Join-Lambert O, Coignard H, Jais J-P, et al. Efficacy of rifampin-moxifloxacin-metronidazole combination therapy in hidradenitis suppurativa. Dermatol Basel Switz. 2011;222:49–58.

18. Delage M, Jais J-P, Lam T, et al. Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 Hidradenitis Suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients. J Am Acad Dermatol. 2020;

19. Armyra K, Kouris A, Markantoni V, et al. Hidradenitis suppurativa treated with tetracycline in combination with colchicine: a prospective series of 20 patients. Int J Dermatol. 2017;56:346–350.

20. Delaunay J, Villani AP, Guillem P, et al. Oral ofloxacin and clindamycin as an alternative to the classic rifampicin–clindamycin in hidradenitis suppurativa: retrospective analysis of 65 patients. Br J Dermatol. 2018;178:e15–e16.

21. Fania L, Clemente A, Sampogna F, et al. Intralesional ultrasound-guided combined treatment with triamcinolone plus lincomycin in hidradenitis suppurativa: A pilot study. Dermatol Ther. n/a:e13901.

22. Hessam S, Sand M, Meier NM, et al. Combination of oral zinc gluconate and topical triclosan: An anti-inflammatory treatment modality for initial hidradenitis suppurativa. J Dermatol Sci. 2016;84:197–202.

23. McPhie ML, Bridgman AC, Kirchhof MG. Combination Therapies for Hidradenitis Suppurativa: A Retrospective Chart Review of 31 Patients. J Cutan Med Surg. 2019;23:270–276.

24. Włodarek K, Ponikowska M, Matusiak Ł, et al. Biologics for hidradenitis suppurativa: an update. Immunotherapy. 2018;11:45–59.

25. Brunasso AMG, Delfino C, Massone C. Hidradenitis suppurativa: are tumour necrosis factor-α blockers the ultimate alternative? Br J Dermatol. 2008;159:761–763.

26. Kozub P, Simaljakova M. Hidradenitis suppurativa treated with combination of infliximab and dapsone. Bratisl Lek Listy. 2012;113:319–323.

27. Saunte DML, Jemec GBE. Hidradenitis Suppurativa: Advances in Diagnosis and Treatment. JAMA. 2017;318:2019–2032.

28. Ring HC, Thorsen J, Saunte DM, et al. The Follicular Skin Microbiome in Patients With Hidradenitis Suppurativa and Healthy Controls. JAMA Dermatol. 2017;153:897–905.

29. Guet-Revillet H, Jais J-P, Ungeheuer M-N, et al. The Microbiological Landscape of Anaerobic Infections in Hidradenitis Suppurativa: A Prospective Metagenomic Study. Clin Infect Dis. 2017;65:282–291.

30. Pradhan S, Madke B, Kabra P, et al. Anti-inflammatory and Immunomodulatory Effects of Antibiotics and Their Use in Dermatology. Indian J Dermatol. 2016;61:469–481.

31. Marasca C, Tranchini P, Marino V, et al. The pharmacology of antibiotic therapy in hidradenitis suppurativa. Expert Rev Clin Pharmacol. 2020;13:521–530.

32. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol JEADV. 2015;29:619–644.

33. Tsankov N, Angelova I. Rifampin in dermatology. Clin Dermatol. 2003;21:50–55.

34. Spízek J, Rezanka T. Lincomycin, clindamycin and their applications. Appl Microbiol Biotechnol. 2004;64:455–464.

35. Powell, Dawber, Gatter. Folliculitis decalvans including tufted folliculitis: clinical, histological and therapeutic findings. Br J Dermatol. 1999;140:328–333.

36. Join-Lambert O, Ribadeau-Dumas F, Jullien V, et al. Dramatic reduction of clindamycin plasma concentration in hidradenitis suppurativa patients treated with the rifampin-clindamycin combination. Eur J Dermatol EJD. 2014;24:94–95.

37. Bessaleli E, Scheinfeld N. Clostridium difficile arising in a patient with hidradenitis suppurativa on clindamycin and rifampin. Dermatol Online J. 2018;24.

38. Brown KA, Khanafer N, Daneman N, et al. Meta-Analysis of Antibiotics and the Risk of Community-Associated Clostridium difficile Infection. Antimicrob Agents Chemother. 2013;57:2326–2332.

39. Arditi M, Yogev R. In vitro interaction between rifampin and clindamycin against pathogenic coagulase-negative staphylococci. Antimicrob Agents Chemother. 1989;33:245–247.

40. Guet-Revillet H, Coignard-Biehler H, Jais J-P, et al. Bacterial Pathogens Associated with Hidradenitis Suppurativa, France. Emerg Infect Dis. 2014;20:1990–1998.

41. Leung YY, Hui LLY, Kraus VB. Colchicine --- update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015;45:341–350.

42. Gupta M, Mahajan VK, Mehta KS, et al. Zinc Therapy in Dermatology: A Review. Dermatol Res Pract [Internet]. 2014 [cited 2020 Jul 26];2014. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4120804/.

43. Molinelli E, Campanati A, Ganzetti G, et al. Biologic Therapy in Immune Mediated Inflammatory Disease: Basic Science and Clinical Concepts. Curr Drug Saf. 2016;11:35–43.

44. Fardet L, Dupuy A, Kerob D, et al. Infliximab for severe hidradenitis suppurativa: transient clinical efficacy in 7 consecutive patients. J Am Acad Dermatol. 2007;56:624–628.

45. Grant A, Gonzalez T, Montgomery MO, et al. Infliximab therapy for patients with moderate to severe hidradenitis suppurativa: a randomized, double-blind, placebo-controlled crossover trial. J Am Acad Dermatol. 2010;62:205–21