Hidradenitis Suppurativa Hurley Stage I: What to Do When Initial Therapy Fails to Reduce Nodules and Abscesses

Clinical scenario

Adult patient (not pregnant) with Hidradenitis suppurativa at Hurley stage I — characterised by recurrent nodules and abscesses with minimal scar formation.

When first-line therapy is insufficient

Standard first-line management — comprising topical clindamycin, intralesional triamcinolone into inflamed lesions, oral tetracycline, and lifestyle counselling (smoking cessation, weight loss) — has not achieved the target goals of reduced pustules and a meaningful reduction in abscesses. A structured next-line protocol is indicated.

Next-line approach (overview only)

The second-line regimen involves a combination of two oral antibiotics — clindamycin paired with rifampin — which has been studied in Hidradenitis suppurativa more than most other antibiotic combinations and is recognised as effective for mild-to-moderate disease at this stage. The complete protocol, including sequence and duration, is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.jaad.2019.02.067

Hurley stage I is characterized by recurrent nodules and abscesses with minimal scar, Hurley stage II is characterized by 1 or a limited number of sinuses and/or scarring within a body region, and Hurley stage III is characterized by multiple or extensive sinuses and/or scarring.

Clindamycin and rifampin in combination is effective as a second-line treatment for mild-to-moderate disease or as a first-line or adjunct treatment in severe disease.

Clindamycin and rifampin in combination have been studied in HS more than most other antibiotics, typically with both used at a dose of 300 mg twice daily.

Treatment typically lasts 8 to 12 weeks and can be repeated intermittently as monotherapy in patients with mild-to-moderate disease or as adjuvant therapy in those with severe disease.

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