The significance of bacterial findings in HS is controversial. While bacteria are likely to be involved in the pathogenesis to some extent, it is probably in a role similar to that in acne in early lesions. In later stages of the disease bacterial infection seems to be a risk factor for the destructive scarring and progression of HS lesions. Coagulase-negative staphylococci are the most common bacteria found in cultures from the deep portions of HS lesions, as seen following carbon dioxide laser surgery [1]. An extensive review of HS bacteriology is found in Chaps. 11 and 15. Although the influence of bacteria is unclear, topical as well as systemic antibiotics are frequently used in treatment of HS.

There are two published randomized controlled trials of topical treatment of HS, both of them evaluating the use of clindamycin [2, 3]. Clemmensen [2] included 30 patients with HS of axillae and/or groin. In total 27 patients (21 women, 6 men) of mean age 31.3 years and mean duration of HS 5.5 years were included in the study. The patients were stratified according to the severity of HS, but the overall disease activity was moderate. A double-blind trial was performed with either a solution of clindamycin hydrochloride 1% in a vehicle of isopropanol 80%, propylene glycol 10% and water 9%, or placebo (vehicle) applied for 12 weeks. The patients were evaluated every 4 weeks and the number of pustules, inflammatory nodules, and abscesses were counted. Self-assessment by the patients was made in diaries by recording the intensity and number of elements, as well as the frequency and duration of recurrences. An overall estimation of the effect of treatment was based on a cumulated score of the parameters recorded (patient's assessments, number of inflammatory nodules, abscesses, and pustules). In all, 13 patients received active treatment and 14 received placebo. An overall improvement was seen in the clindamycin group at each monthly evaluation, and statistically significant improvement was found in the clindamycin group for each parameter except for inflammatory nodules at 1 and 2 months of treatment. Clindamycin was more effective than placebo.

Jemec and Wendelboe [3] compared topical clindamycin with systemic tetracycline in a double-blind, double-dummy controlled trial. In total 46 patients with HS stage I and II disease, according to Hurley's classification, were included, of which 34 (28 women, 6 men) were available for evaluation. After computerized blinded randomization the patients received a minimum of 3 months of therapy with active systemic plus topical placebo or systemic placebo plus active topical treatment. The active systemic treatment consisted of tetracycline 1 g (capsules 250 mg, 2x2) daily per os; active topical, 1% clindamycin phosphate in a vehicle of propylene glycol, isopropyl alcohol and water, applied twice daily. Uniform containers, placebo tablets and placebo lotion were used. At monthly visits the following outcome variables were evaluated: patient's global evaluation using a 100-mm visual analog scale (VAS) score, VAS score of soreness, physician's global evaluation (VAS score) and the number of abscesses and nodules. No significant differences were found between the two treatments, but significant changes occurred in the course of the study. Abscesses were reduced during the first 3 months of the study while nodules became reduced in numbers after 3 months of treatment. There was a progressive improvement in both the patient's and the physician's overall assessment, although the VAS score of soreness did not change during the study.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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