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This table outlines the recommended medical management steps for hidradenitis suppurativa, including topical and systemic antibiotic options and the assessment process. This is based on the BAD guidelines.
| Medical Management | Recommendations |
|---|---|
| Topical Antibacterial Preparations | - Use regularly to reduce skin carriage of bacteria. |
| - Consider the following options: | |
| 1. Chlorhexidine 4% wash – can be used as a soap | |
| substitute but should be washed off after five minutes. | |
| 2. Clindamycin 1% twice daily for localized cases – | |
| avoid alcoholic preparations due to stinging. | |
| Systemic Antibiotics (First Line) | - Consider Tetracyclines as the first-line treatment. |
| - Options include: | |
| - Lymecycline: 408 mg daily for 12 weeks. | |
| - Doxycycline: 100 mg daily (can be increased to twice | |
| daily for severe symptoms) for 12 weeks. | |
| - For acute flare-ups, consider: | |
| - Stopping lymecycline/doxycycline and giving flucloxacillin | |
| for no more than 2 weeks. | |
| - If penicillin allergic, consider clindamycin. | |
| - Antibiotics options: | |
| - Flucloxacillin: 500mg QDS for 7-10 days. | |
| - Clindamycin (if penicillin-allergic): 300mg QDS (can | |
| increase to 450mg QDS) for 7-10 days. | |
| Assessment at 12 Weeks | - Assess pain, lesion count, and number of flares in the |
| last month. | |
| Lack of Response | - If there is no response, refer to the dermatologist-led... |
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