From the Guidelines
Doxycycline is a recommended treatment option for hidradenitis suppurativa (HS), particularly for patients with mild to moderate disease with inflammatory lesions, as supported by the most recent guidelines 1. The typical regimen is doxycycline 100 mg twice daily for at least 3 months, though some patients may require longer treatment courses. For maintenance therapy, a lower dose of 100 mg once daily may be used. Patients should take doxycycline with a full glass of water, either with or without food, though taking it with food can reduce stomach upset. It's essential to avoid taking doxycycline with dairy products, antacids, or iron supplements as these can reduce absorption. Common side effects include photosensitivity (increased sun sensitivity), nausea, and yeast infections. Patients should use sun protection while on this medication. Doxycycline works in HS by both reducing bacteria and decreasing inflammation through inhibition of pro-inflammatory cytokines and matrix metalloproteinases.
Some key points to consider when using doxycycline for HS include:
- The importance of patient education on proper use and potential side effects
- Regular monitoring for signs of improvement or adverse effects
- Consideration of combination therapy or referral to dermatology for severe or resistant cases
- The need for individualized treatment plans based on disease severity and patient-specific factors
The most recent guidelines 1 provide expert consensus recommendations on the treatment of HS, including the use of doxycycline, and emphasize the importance of evidence-based management. While other studies, such as 1 and 1, provide additional information on the treatment of HS and acne, the most recent guidelines 1 take precedence in terms of recommendations for clinical practice.
From the Research
Doxycycline for Hidradenitis Suppurativa
- Doxycycline is an antibiotic that has been used to treat hidradenitis suppurativa (HS), a chronic inflammatory disease characterized by painful, deep-seated nodules, abscesses, and draining tunnels in the skin 2.
- A study compared the efficacy of subantimicrobial, modified-release doxycycline (MR-DC) to regular-release doxycycline (RR-DC) for the treatment of HS, and found that MR-DC demonstrated comparable efficacy to RR-DC in reducing the International Hidradenitis Suppurativa Severity Score System (IHS4) and the Dermatology Life Quality Index (DLQI) 2.
- The use of doxycycline for HS is not limited to its antimicrobial properties, but also its anti-inflammatory effects, which may be beneficial in reducing the severity of the disease 2.
- Other treatment options for HS include topical and systemic antibiotics, retinoids, hormonal and metabolic therapies, biologics and small molecule inhibitors, systemic immunosuppressants, surgical treatment, pain management, lifestyle modifications, adjunctive treatment, wound care, and flare therapy 3, 4, 5, 6.
Treatment Guidelines
- The management of HS typically involves a multimodal approach, with treatment stacking of various therapies, including topical and systemic antibiotics, retinoids, hormonal and metabolic therapies, biologics and small molecule inhibitors, systemic immunosuppressants, surgical treatment, pain management, lifestyle modifications, adjunctive treatment, wound care, and flare therapy 6.
- The choice of treatment depends on the severity, extent, and impact of the disease on the patient's quality of life, as well as the presence of comorbidities 3, 4, 5, 6.
- Early intervention and diagnosis are crucial in preventing irreversible skin damage and mitigating extra-cutaneous comorbidities 5.
Efficacy of Doxycycline
- A study found that 64% of patients receiving MR-DC and 60% of those receiving RR-DC achieved a clinical response, as measured by the Hidradenitis Suppurativa Clinical Response (HiSCR) 2.
- The use of doxycycline for HS has been shown to reduce the severity of the disease, improve quality of life, and mitigate symptoms, including pain 2.