From the Guidelines
For hidradenitis suppurativa, the most effective topical treatment option is Clindamycin 1% solution or gel applied twice daily to affected areas, as it helps reduce bacterial load and inflammation, with a Level of Evidence IIb and Strength of Recommendation B 1. When considering treatment options for hidradenitis suppurativa, it's essential to evaluate the severity of the disease and the presence of scarring. The European Dermatology Forum guidelines recommend a holistic evidence-based approach, including adjuvant therapy, disease severity scores, and patient-reported outcomes 1.
- Key considerations for topical treatment include:
- Reducing bacterial load and inflammation
- Managing pain and discomfort
- Promoting wound healing
- Preventing scarring and sinus tract formation According to the European guidelines, topical Clindamycin 1% solution or gel is a recommended treatment option for mild disease, with a treatment duration of 12 weeks 1.
- Other treatment options, such as Tetracycline, Clindamycin with Rifampicin, and Adalimumab, may be considered for more widespread or severe disease, but these are typically systemic treatments rather than topical options 1. It's crucial to note that topical treatments work best for mild disease (Hurley stage I) or as adjuncts to systemic therapy in more severe cases, and that treatment should be tailored to the individual patient's needs and disease severity 1.
From the FDA Drug Label
Apply a thin film of Clindamycin Phosphate Topical Solution, Clindamycin Phosphate Lotion, or Clindamycin Phosphate Gel twice daily to affected area. For Hidradenitis suppurativa, one possible ointment option is Clindamycin Phosphate in the form of:
- Topical Solution
- Lotion
- Gel Apply twice daily to the affected area 2.
From the Research
Hidradenitis Suppurativa Ointment Options
- Topical resorcinol 15% has been shown to be effective in the management of mild-to-moderate hidradenitis suppurativa, with significant improvement in clinical response and pain reduction compared to topical clindamycin 1% 3.
- Topical clindamycin 1% has been used as a first-line treatment for mild-to-moderate hidradenitis suppurativa, with studies demonstrating its efficacy in reducing symptoms and improving quality of life 4.
- Other topical agents that may be used to control pain in hidradenitis suppurativa include:
- Diclonefac gel 1%
- Liposomal xylocaine 4% and 5% cream or 5% ointment
- Topical ketamine
- Topical doxepin (3% or 3.3% concentration)
- Topical amitriptyline
- Gabapentin and pregablin (in compounded analgesic preparations) 5
- Systemic therapies, such as oral antibiotics (e.g. tetracycline, doxycycline, and lymecycline) and biologics (e.g. adalimumab, secukinumab, and bimekizumab), may also be used to treat hidradenitis suppurativa, particularly in moderate-to-severe cases 6, 7