Would doxycycline be an appropriate treatment for a 26-year-old male patient with hidradenitis suppurativa and what is the recommended dosage and duration?

Doxycycline Treatment for Hidradenitis Suppurativa

Doxycycline 100 mg twice daily for 12 weeks is the recommended first-line antibiotic treatment for this patient with recurrent hidradenitis suppurativa lesions. 1

Treatment Rationale and Dosing

Doxycycline is an appropriate first-line therapy for this 26-year-old male patient with mild-to-moderate hidradenitis suppurativa (HS) based on:

• His presentation with recurrent axillary lesions suggests Hurley stage I-II disease
• Recent smoking cessation (1 month ago) is positive but requires additional medical therapy
• Doxycycline provides both antimicrobial and anti-inflammatory effects

Recommended Regimen:

• Initial dose: 100 mg twice daily for 1-2 weeks
• Maintenance dose: 100 mg once daily
• Total duration: 12 weeks 1, 2

Evidence Supporting This Recommendation

The American Academy of Dermatology recommends tetracyclines, particularly doxycycline, as first-line therapy for mild-to-moderate HS 1. Doxycycline is the most commonly prescribed antibiotic for HS (66% of patients in real-world data) 2.

In clinical practice, doxycycline is typically administered at 100 mg twice daily initially, then reduced to once daily for maintenance, with a total treatment duration of 12 weeks 2. This regimen has shown significant improvement in disease severity scores and quality of life measures 3.

Monitoring and Follow-up

• Assess treatment response after 12 weeks using:
  • Reduction in inflammatory lesion count
  • Improvement in pain levels
  • Quality of life measures
• If inadequate response after 12 weeks, consider escalating to clindamycin + rifampin combination therapy (both at 300 mg twice daily for 10-12 weeks) 4, 1

Important Considerations and Alternatives

Potential Side Effects:

• Photosensitivity (advise sun protection)
• Gastrointestinal disturbances
• Risk of bacterial resistance (consider adding antiseptic washes)

Alternative Options:

1. If doxycycline is ineffective or not tolerated:

   • Minocycline (alternative tetracycline)
   • Clindamycin + rifampin combination (for more severe disease)

2. For more severe disease (Hurley stage II-III):

   • Consider biologics (adalimumab) if antibiotics fail
   • Surgical options for persistent lesions

Additional Management Recommendations

• Continue smoking cessation efforts (critical for disease control)
• Weight management if applicable (BMI appears elevated at 28.3)
• Consider antiseptic washes (chlorhexidine, zinc pyrithione) to decrease bacterial resistance 1
• Avoid simple incision and drainage except for acute painful abscesses 1

Treatment Algorithm

1. First-line: Doxycycline 100 mg BID for 1-2 weeks, then 100 mg daily for total of 12 weeks
2. If inadequate response: Clindamycin + rifampin combination (both 300 mg BID for 10-12 weeks)
3. For persistent disease: Consider biologics (adalimumab) or surgical options (deroofing for recurrent nodules)

Doxycycline has demonstrated comparable efficacy to other antibiotic regimens with the advantage of fewer side effects and lower potential for inducing antibiotic resistance, especially when used at subantimicrobial doses 5.