From the Guidelines
Topical clindamycin 1% lotion is recommended for the treatment of Hidradenitis Suppurativa (HS), applied twice daily for 3 months, as a first-line treatment option for patients with mild HS-PGA or localized Hurley I/mild Hurley II stage. This recommendation is based on the European guidelines for hidradenitis suppurativa, which suggest that topical clindamycin is effective in reducing the bacterial load and inflammation in HS lesions 1. The proposed dosing regimen is twice daily, for 3 months, and if clinical response is not achieved after that treatment period, other treatment options must be considered.
Key Considerations
- Topical clindamycin 1% lotion is recommended for mild to moderate HS, and its efficacy has been described in a double-blind, placebo-controlled, randomized trial in HS patients with Hurley stage I or mild stage II 1.
- The medication should be applied to clean, dry skin, covering all affected areas including lesions and surrounding skin.
- Patients may need to continue treatment for extended periods as HS is a chronic condition requiring ongoing management.
- Topical clindamycin works by inhibiting bacterial protein synthesis, reducing the bacterial load that contributes to inflammation in HS lesions.
- While it can be effective for mild disease, more severe cases often require systemic antibiotics, biologics, or surgical interventions.
Alternative Treatment Options
- If no improvement is seen after 3 months, patients should consult their healthcare provider to consider alternative or additional treatments, such as oral tetracyclines, combination treatment with oral clindamycin and rifampicin, or adalimumab 1.
- Topical clindamycin can be used as part of a comprehensive treatment approach that may include lifestyle modifications and other medications.
Important Notes
- The British Association of Dermatologists guidelines for the management of hidradenitis suppurativa recommend considering topical clindamycin 1% solution in people with HS, and measuring treatment response using recognized instruments for pain and quality of life 1.
- The guidelines also recommend screening people with HS for associated comorbidities, including depression, anxiety, and cardiovascular risk factors, and referring them to smoking-cessation and weight-management services as needed 1.
From the Research
HS Topical Clindamycin Dosing and Length of Time
- The recommended dosing of topical clindamycin for the treatment of Hidradenitis Suppurativa (HS) is 1% solution, as used in the studies 2, 3, 4.
- The length of time for topical clindamycin treatment varies:
- In the RELIEVE study 2, patients received topical clindamycin 1% solution for 16 weeks.
- In the study comparing topical resorcinol 15% versus topical clindamycin 1% 3, patients were treated for 12 weeks.
- In the pilot study comparing clindamycin-benzoyl peroxide gel with clindamycin lotion 4, patients were treated for 12 weeks, with a follow-up at 16 weeks.
- It is essential to note that the treatment duration and dosing may vary depending on the severity of HS and individual patient response, as well as the specific treatment guidelines and recommendations from healthcare professionals.
Treatment Efficacy and Safety
- Topical clindamycin 1% solution has been shown to be effective in reducing disease severity and improving quality of life in patients with mild-to-moderate HS 2, 4.
- The combination of topical clindamycin with other treatments, such as LAight® therapy 2 or benzoyl peroxide 4, may enhance treatment efficacy.
- Topical clindamycin is generally well-tolerated, with mild and transitory side effects 2, 4.
Comparison with Other Treatments
- Topical resorcinol 15% has been shown to be a valid alternative to topical clindamycin 1% in the management of mild-to-moderate HS, with significant improvements in clinical response and patient-reported outcomes 3.
- Clindamycin-benzoyl peroxide gel has been found to have similar clinical efficacy to clindamycin lotion, suggesting it could be a suitable replacement to prevent antibiotic resistance 4.