Clindamycin-benzoyl peroxide gel may reduce antibiotic resistance and improve clinical efficacy in hidradenitis suppurativa

Antibiotic resistance is a significant concern in HS, and antibiotics form a cornerstone in its treatment. Topical clindamycin causes bacterial resistance, but for managing HS (mild to moderate), it is still advised as monotherapy.

In this study, researchers compared the clinical efficacy of clindamycin-benzoyl peroxide gel with clindamycin lotion in patients with mild to moderate HS. They measured the difference in the IHS4 or International Hidradenitis Suppurativa Severity Score after 12 weeks between the two groups as the primary outcome. The study's secondary objectives were the intra-patient design's feasibility, the treatment's efficacy within each group, its impact on HS pain and itch, patient satisfaction, the effect on antibiotic resistance, and the prolonged efficacy up to 16 weeks.

The key results of the study are:

• A total of 10 patients were included.
• There were two groups of 10 treated body sites.
• Researchers found no significant differences between the two groups after 12 or 16 weeks (for all measurements).
• Both therapies improved IHS4, pain, and itch scores.
• IHS4 decreased for the clindamycin lotion and the clindamycin-benzoyl peroxide gel following 16 weeks.
• Pain scores reduced from 7 to 2.5 and 6.5 to 3, respectively.
• Using the IHS4-55, researchers identified 50% of patients as responders in both groups after 12 weeks.

They noted that researchers reported favourable and similar clinical efficacy results for topical clindamycin-benzoyl peroxide gel and clindamycin lotion.

However, we encountered limitations due to the intra-patient design for the mild to moderate HS patient population. They said that more extensive randomized controlled trials are necessary to validate topical combination therapies' effectiveness and their impact on the diversity and resistance patterns in the skin microbiome more comprehensively.

Further reading:

Aarts, P., Reeves, J. L., Ardon, C. B., Van Der Zee, H. H., & Prens, E. P. (2023). Clindamycin-benzoyl peroxide gel compared with clindamycin lotion for hidradenitis suppurativa; a randomized controlled assessor blinded intra-patient pilot study. Dermatology, 239(4), 670–674.