From the Guidelines
For hidradenitis suppurativa flares in patients with clindamycin allergy, benzoyl peroxide 5-10% applied once or twice daily to affected areas is a recommended alternative topical treatment. This recommendation is based on the most recent and highest quality study available, which provides an evidence-based approach to the treatment of hidradenitis suppurativa 1.
Alternative Topical Treatments
Other alternative topical treatments include:
- Topical dapsone 5% gel applied twice daily to reduce inflammation
- Topical gentamicin or mupirocin if bacterial infection is suspected
- Chlorhexidine wash (4%) to help with antisepsis when used daily
- Warm compresses for 10-15 minutes several times daily to help drain lesions, followed by application of antiseptic solutions
- Tea tree oil diluted to 5% in a carrier oil to provide some antimicrobial benefit when applied twice daily
These alternatives work through different mechanisms, such as benzoyl peroxide having antimicrobial and anti-inflammatory properties, dapsone reducing neutrophil activity, and antiseptics decreasing bacterial load 1.
Considerations for Treatment
It's essential to note that topical treatments are generally most effective for mild disease, and moderate to severe hidradenitis suppurativa often requires systemic therapy. If symptoms don't improve within 1-2 weeks, oral antibiotics (non-clindamycin) or referral to dermatology should be considered. The treatment approach should be based on the evaluation of the inflammatory components as well as the scarring and should be directed by evidence-based guidelines 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION: Erythromycin Topical Solution should be applied over the affected areas twice a day (morning and evening) after the skin is thoroughly washed with warm water and soap and patted dry. The answer to the question of a topical treatment for hidradenitis suppurativa flare if there's an allergy to clindamycin is erythromycin topical solution. It can be applied over the affected areas twice a day. 2
From the Research
Topical Treatment for Hidradenitis Suppurativa Flare
If a patient is allergic to clindamycin, alternative topical treatments for hidradenitis suppurativa (HS) flares can be considered.
- The studies provided do not directly address topical treatment options for HS flares in patients with a clindamycin allergy 3, 4, 5, 6, 7.
- However, it is known that HS treatment often involves a combination of topical and systemic therapies, with the goal of reducing inflammation, preventing infection, and promoting wound healing.
- For patients with a clindamycin allergy, other topical antibiotics or anti-inflammatory agents may be considered as alternatives, although the specific options are not discussed in the provided studies.
- Systemic therapies, such as those targeting TNF or IL-17, may also be considered for moderate-to-severe HS, as discussed in 3.
- It is essential to consult a healthcare professional for personalized treatment recommendations, as the best course of treatment will depend on the individual patient's needs and medical history.