Efficacy and safety of topical resorcinol 15% as long‐term treatment of mild‐to‐moderate hidradenitis suppurativa: a valid alternative to clindamycin in the panorama of antibiotic resistance

Abstract

Funding sources: none. Conflicts of interest: The authors declare they have no conflicts of interest. Dear Editor, Hidradenitis suppurativa (HS) is a chronic inflammatory disease that affects the hair follicle in the apocrine gland‐bearing regions.1 Although HS is not primarily caused by bacterial infection, antibiotics represent the first‐line treatment in the management of HS primarily for their anti‐inflammatory properties, with additional contributions via antimicrobial and immunomodulatory effects.2, 3 Topical clindamycin and oral tetracyclines are the mainstays of the antibiotic approach in mild‐to‐moderate HS, although their use is largely based on clinical experience and a few clinical trials.3 Antimicrobial resistance raises questions regarding the balance of antibiotic use vs. potential harms associated with antibiotic resistance. The emergence of resistant bacterial strains in HS lesions (that are normally dominated by Staphylococcus aureus, coagulase‐negative staphylococcal species and mixed anaerobic bacteria) has been reported.2 In our study, the efficacy of topical 15% resorcinol as an alternative to clindamycin in mild‐to‐moderate HS was investigated using clinical and ultrasound evaluation. Sixty‐one patients (males and females aged ≥ 18 years old) affected by Hurley stage I and II HS were evaluated. The study was conducted according to the principles of the Declaration of Helsinki. All included participants applied topical 15% resorcinol (incorporated in an oil/water cream as galenic product) once daily for 12 weeks in inflammatory HS lesions, including subcutaneous nodules, abscesses and sinus tracts. All patients were examined clinically and with ultrasonography at baseline, and at 4 and 12 weeks.4 Clinical response [according to the Hidradenitis Suppurativa Clinical Response (HiSCR) measure] was achieved in 32 (52%) and 52 (85%) patients after 4 and 12 weeks, respectively (P < 0·001). Response to resorcinol was higher in patients in Hurley stage I than stage II, with no statistically significant difference between the two categories (P = 0·21). Patients had a significant reduction in mean pain visual analogue scale and Dermatology Life Quality Index scores (P < 0·001) and a significant decrease in International Hidradenitis Suppurativa Severity Score System (IHS4) score from baseline both at 4 (P < 0·001) and 12 (P < 0·05) weeks of resorcinol application. A total of 132 lesions – divided into 68 nodules, 39 abscess and 25 draining tunnels – were examined sonographically. At 12 weeks, the number of nodules and abscesses decreased by 80% and 87%, respectively (P < 0·001) and the average reduction in size of the remaining lesions was statistically significant (P < 0·001). Although the sinus tract count remained roughly unchanged, the reduction in the average length and thickness of the draining tunnels from baseline at day 4 and at 12 weeks was statistically significant (P < 0·001). Mild irritation, desquamation and reversible brown discoloration were experienced by 21, 39, and 25 of participants, respectively. None of the patients discontinued treatment (Table 1).

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