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Combination Treatments in HS Require Further Review


A systematic review found that generally, combination therapy has evidence supportive of its efficacy in hidradenitis suppurativa.

Key Takeaways

  • The review highlights the scarcity of robust evidence supporting the efficacy of combination treatments for hidradenitis suppurativa (HS).
  • Among the studies examined, the combination of oral clindamycin and rifampicin, each dosed at 600 mg daily, was commonly studied. Some cases showed complete remission of HS, but side effects like diarrhea and candida vaginitis were reported, along with instances of relapse.
  • The review underscores the need for further research through randomized controlled trials to substantiate the potential benefits of combination therapy for HS, as most current evidence is derived from observational studies and case reports.

In the treatment of hidradenitis suppurativa (HS), combination treatments have demonstrated varying degrees of efficacy. However, according to a recent review1 of the role of combination therapies in HS, researchers say more evidence is needed stemming from larger, more robust studies of a prospective nature to reaffirm such findings.

The review, published in SKIN: The Journal of Cutaneous Medicine, sought to provide a comprehensive review of combination treatment modalities and their efficacy in patients with HS.

Using electronic databases such as ACP Journal Club, Central Register of Controlled Trials, Cochrane Database of Systemic Reviews, the Database of Abstracts of Review of Effectiveness, and Ovid Medline, investigators Mostafa et al searched for relevant articles published up until May 2023. Studies were eligible for review if they had been published in English, exclusively involved human subjects, and could be classified as case reports, case studies, clinical trials, or cohort studies wherein 2 or more systemic medical therapeutic options were employed in the course of treatment.

Of the 19 studies eligible for review, 12 studies to date have involved the combined use of oral clindamycin and rifampicin, with a typical 600 mg daily dose per drug. Among 3 studies, complete remission of HS was reported, ranging from 1% to 57% of patients achieving remission. Four studies described relapse after cessation of treatment. Side effects involved diarrhea, gastrointestinal problems, and candida vaginitis.

Two of the 19 studies explored the combination of rifampicin-moxifloxacin-metronidazole and found that of 28 patients with HS, 16 individuals achieved clinical remission. Side effects were similar to that of the clindamycin and rifampicin combination, with some reports of moxifloxacin tendinitis, mucosal candidiasis, and asthenia.

Additional combination treatment modalities included the inclusion of an antibiotic, such as in the cases of minocycline and colchicine, clindamycin and ofloxacin, and triamcinolone and lincomycin, among others. Three studies involved non-antibiotic treatments.

Potential study limitations included the quantity of studies included in the review, variance in study outcomes assessed by researchers, and the retrospective or unblinded nature of the eligible studies.

“The current evidence depicts combination therapy as a potentially beneficial treatment modality for HS,” wrote Mostafa et al. “However, the current literature is composed mostly of observational studies and case reports and thus, further research in the form of randomized controlled trials comparing combination treatment to existing interventions is required.”


  1. Mostafa, N., Phan , K., & Yazdabadi, A. (2023). Combination treatment for hidradenitis suppurativa. SKIN J Cutan Med, 7(5), 962–975. https://doi.org/10.25251/skin.7.5.1
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