Patients with plaque psoriasis have a reduced health-related quality of life, mainly in terms of emotional aspects.

Metabolic syndrome and psoriatic arthritis (PsA) are important comorbidities among patients with plaque psoriasis (PsO), with a reduced health-related quality of life (HRQoL) observed among patients with these comorbid disorders, thus highlighting the relevance of diagnosis and treatment beyond the care of skin lesions. A cross-sectional, observational study on the subject was conducted in 9 tertiary centers in southeastern, southern, and northern Brazilian regions that specialize in the treatment of PsO. Findings from the analysis were published in the Journal of Dermatology.

The investigators sought to assess the prevalence of metabolic syndrome and PsA, as well as to explore HRQoL and the prevalence of secondary comorbidities such as hypertension, type 2 diabetes mellitus, obesity, and dyslipidemia among the study population. Patients diagnosed with PsO responded to an interview and standardized questionnaires (ie, Dermatology Life Quality Index, 36-Item Short Form Health Survey, and EuroQoL Five-Dimension Questionnaire Three-Level version [EQ-5D-3L]). During 3 visits, a dermatologist and a rheumatologist conducted physical examinations, along with several tests, to evaluate the desired outcomes.

The prevalence of PsA was 41.8% (95% CI, 36.0%-47.6%) among patients who met Classification Criteria for Psoriatic Arthritis (35.7%) and/or had reported a medical history of PsA (23.1%). The prevalence of metabolic syndrome, based on physician diagnosis or history, was 50.0% (95% CI, 44.2%-55.8%). The most prevalent secondary comorbidity reported was dyslipidemia (74.5%), which was followed by hypertension (61.8%), obesity (52.5%), and type 2 diabetes mellitus (30.9%).

The mean Dermatology Life Quality Index score reported was 6.5±6.9. The mean physical and mental 36-Item Short Form Health Survey measures were 45.2±10.4 and 45.5±12.3, respectively. Regarding the EQ-5D-3L, the mean utility index was 0.68±0.27, and the mean EQ-5D-3L visual analog scale was 72.7±19.7. Among the 5 dimensions on the EQ-5D-3L, self-care was the least affected, with 84.6% of the respondents reporting an absence of problems. Moreover, the highest impairment was reported for the dimension of pain and discomfort, with 66.4% of respondents reporting experiencing problems, some problems, or extreme problems. Overall, 9.4% of respondents reported experiencing extreme problems on the dimension of anxiety and depression.

The investigators concluded that the results of this study demonstrate that patients with plaque PsO have a reduced HRQoL, mainly in terms of emotional aspects, thus reinforcing existing data on feelings of stigmatization among these individuals. The findings also demonstrate the relevance of HRQoL scores among this population to evaluate patient response to therapy in a more comprehensive fashion.

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Reference

Souza CS, de Castro CCS, Carneiro FRO, et al. Metabolic syndrome and psoriatic arthritis among patients with psoriasis vulgaris: Quality of life and prevalence [published online November 26, 2018]. J Dermatol. doi: 10.1111/1346-8138.14706.

Patients with rosacea tended to have more coexisting psychiatric disorders, including anxiety, depression, phobic disorder, and obsessive-compulsive disorder.

Patients with rosacea have a 2.76-fold increased risk for developing psychiatric disorders, including anxiety, depression, phobic disorder, and obsessive-compulsive disorder (OCD), according to the results of a nationwide, population-based, cohort study conducted in Taiwan. Findings from the analysis were published in The Journal of Dermatology.

The investigators sought to elucidate the role played by rosacea in various psychiatric disorders via the use of a nationwide database in Taiwan. Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan between 2000 and 2013. Overall, 7881 patients with rosacea and 31,524 age- and gender-matched controls were enrolled in the study.

Patients with rosacea tended to have more coexisting psychiatric disorders compared with controls. After adjusting for age, gender, comorbidities, season of the year, geographic area of residence, urbanization level of residence, and level of care (ie, hospital center, regional hospital, local hospital, or physician clinics), the hazard ratio (HR) of psychiatric disorders in patients with rosacea was 2.761 (95% CI, 2.650-2.877; P <.001). Among the possible psychiatric disorders, the highest adjusted HRs were for phobic disorder (HR 7.841; 95% CI, 7.526-8.170; P <.001) and OCD (HR 6.389; 95% CI, 6.132-6.657; P <.001).

In the study, younger patients with rosacea (ie, younger than 45) were at a lower risk for the development of psychiatric disorders.

A major limitation of the study was the fact that the NHIRD of Taiwan does not include information about rosacea subtypes, disease severity, and laboratory parameters; thus, the researchers were unable to clarify whether these factors affect the association of rosacea with psychiatric disorders.

The investigators concluded that rosacea is linked to a number of psychiatric disorders. Additional studies are warranted in order to explore the pathophysiology of rosacea and thus better understand the association of the disease with various psychiatric disorders. By recognizing the psychosocial burden of rosacea, clinicians should be mindful that careful follow-up of the mental health of patients with the disease is critical.

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Reference

Hung C-T, Chiang C-P, Chung C-H, Tsao C-H, Chien W-C, Wang W-M. Risk of psychiatric disorders in rosacea: a nationwide, population-based, cohort study in Taiwan [published online November 22, 2018]. J Dermatol. doi:10.1111/1346-8138.14705

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Pooling data from 11 of 14 relevant studies, patients with atopic dermatitis were 44% more likely to experience suicidal ideation compared with participants without atopic dermatitis.

According to study results published in JAMA Dermatology, individuals with atopic dermatitis are at greater risk of experiencing suicidal ideation and suicide attempts than people without atopic dermatitis.

The investigators of this prospective study sought to evaluate the association between atopic dermatitis and suicidality by reviewing and synthesizing available literature.

A systematic search of relevant articles was conducted through PubMed, Embase, PsycINFO, and Cochrane databases, in which the investigators identified 15 observational studies that evaluated suicidal ideation, suicide attempts, and completed suicide among patients with atopic dermatitis. The investigators performed a meta-analysis to measure the risk between atopic dermatitis and suicidality as a primary end point using pooled odds ratios (OR); the quality of the studies was further assessed as a primary outcome. A total of 4,770,767 participants were analyzed: 310,681 were diagnosed with atopic dermatitis or eczema, and 4,460,086 were used as controls.

Pooling data from 11 of 14 relevant studies, patients with atopic dermatitis were 44% more likely to experience suicidal ideation (pooled OR 1.44; 95% CI, 1.25-1.65) compared with participants without atopic dermatitis. In 3 of 5 relevant studies, patients with atopic dermatitis were also 36% more likely to attempt suicide (pooled OR 1.36; 95% CI, 1.09-1.70) than the control group. The investigators found limited data on completed suicides among patients with atopic dermatitis, and the results from the only 2 relevant studies were inconsistent.

Limitations to the analysis were studies that included control groups of individuals with other medical conditions, potentially confounding results, and several studies that did not include controls or report control group values.

Based on the results, the investigators stressed that dermatologists be aware of this risk and screen for suicidality among their patients with atopic dermatitis.

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Reference                    

Sandhu JK, Wu KK, Bui TL, Armstrong AW. Association between atopic dermatitis and suicidality: a systemic review and meta-analysis [published online December 12, 2018]. JAMA Dermatol. doi: 10.1001/jamadermatol.2018.4566

Emerging evidence points to a potential link between H pylori infection and skin diseases including rosacea.

An estimated 25% to 30% of the general population is infected with Helicobacter pylori (H pylori), a gram-negative bacterium that represents a major cause of stomach ulcers and other gastric issues.¹ Research findings increasingly suggest a connection between H pylori infection and various other medical conditions, such as Parkinson disease, migraines, and iron deficiency anemia.² In addition, emerging evidence points to a potential link between H pylori infection and skin diseases including rosacea.

Numerous studies have demonstrated higher rates of H pylori infection in patients with rosacea compared with control subjects. For example, prospective research published in 2015 tested 90 patients with rosacea and 90 control subjects for H pylori (using the 13C Urea Breath Test and H pylori stool antigen test) and found infection rates of 48.9% and 26.7%, respectively (P =.003).¹ Similar results were not found for small intestinal bacteria overgrowth.

Within 10 weeks following treatment with clarithromycin-containing sequential therapy, skin lesions had decreased significantly or completely resolved in 97.2% of patients in whom H pylori was eradicated (P <.0001). For cases in which treatment did not eradicate H pylori infection, lesions were reduced or eliminated in 37.5% of patients. These results align with those of many other studies showing a higher prevalence of H pylori in patients with rosacea vs controls and showing resolution of symptoms following eradication of the bacteria.

Among the potential mechanisms underlying these associations, increased levels of reactive oxygen species and nitric oxide by H pylori have been associated with inflammation and vasodilatation in rosacea.³ Other evidence has revealed that “cytotoxin-associated gene A, known as a H pylori virulence factor, facilitated the secretion of proinflammatory cytokines in the gastric epithelium, and the presence of cytotoxin-associated gene A antibodies was observed in patients with rosacea.”³

Several other studies, however, have not found a higher prevalence of H pylori in people with rosacea or an improvement in symptoms after eradication of H pylori. As rosacea is a multifactorial disease, it is possible that H pylori is a contributing factor in certain patients with specific subtypes of the disease. In support of this, some studies have noted a more favorable treatment response among patients with papulopustular rosacea compared with other subtypes.

One such investigation conducted in 2012 found more frequent rates of gastric ulceration and an especially high response to eradication therapy in patients with papulopustular rosacea.⁴ The study authors concluded that “H pylori plays an important role in rosacea patients with concomitant dyspeptic problems, especially in the papulopustular subtype.”

It is also notable that there are different strains of H pylori with varying levels of virulence, a range of statistical methods and assessments for H pylori have been used in studies on the topic, and the previous use of antibiotics in people with rosacea may influence results.⁴ These factors may further explain the divergent findings observed across studies. Additional research is needed to clarify these points.

Dermatology Advisor spoke with Suzan Obagi, MD, director of the UPMC Cosmetic Surgery and Skin Health Center and the 2018 president of the American Academy of Cosmetic Surgery, regarding the potential significance of H pylori in rosacea.

Dermatology Advisor: What does the research suggest thus far about associations between rosacea and H pylori, as well as underlying mechanisms?

Dr Obagi: There is growing evidence of the link between what we eat and drink and inflammation in the body and skin. Like the digestive tract, skin is one of the largest organs and has its own immune system, and the link between these 2 systems is becoming clearer. The foods and drinks we consume can alter the gut microbiome, allowing unhealthier bacteria to grow and crowd out the healthier bacteria.

It turns out that the unhealthy bacteria can damage the intestinal lining and cause the gut to become “leaky,” thus allowing substances to enter the bloodstream that should be kept out. These are inflammatory substances, immune triggering proteins, and the very harmful endotoxins produced by bacteria. Additionally, ingesting even moderate amounts of alcohol can reduce the production of healthy bile acids by our gut and thus foster the growth of unhealthy bacteria. Lastly, high glycemic foods can feed the unhealthy bacteria and increase the systemic inflammatory response.

There is growing scientific evidence that gut health is intricately linked with overall health, beyond just skin. We are now finding ties between the microbiome and dementia, diabetes, heart disease, cancer, and skin conditions. H pylori is probably just one small example of this issue. H pylori infection causes stomach ulcers in many people but can be silent in others.

In some patients with active infection, their skin shows symptoms of inflammation such as a rosacea flare. In these people, treating the infection can help clear their skin. However, for some people with rosacea, they have active rosacea and no H pylori infection. That suggests a different contributing factor, and other causes of gut issues should be considered.

We know that there is a link between the skin and the gut in atopic dermatitis, acne, rosacea, and now, based on some convincing studies, probably a link with psoriasis, hidradenitis suppurativa, pyoderma gangrenosum, and inflammatory bowel disease as well. 

Dermatology Advisor: What are additional treatment recommendations for clinicians?

Dr Obagi: I think that any clinician who is keeping up with the science is starting to have discussions with their patients about mediating inflammation, which is the root cause of most of the conditions I mentioned above. One of the ways our patients can mitigate inflammation is to improve their overall gut health by taking probiotics (especially after taking antibiotics); eating a low glycemic diet; avoiding inflammatory foods such as dairy, gluten, soy, and peanuts; eliminating sugary drinks; and keeping alcohol intake to a minimum. 

Some patients may also require supplementation with vitamins such as quercetin and digestive acids such as bile acids for certain conditions. These suggestions should be implemented in collaboration with the patient’s primary care provider and dermatologist. 

Dermatology Advisor: What are some of the remaining research needs in this area?

Dr Obagi: We need more research on a larger population of patients of various ethnicities to see whether this link pans out across ethnically different patients. We are already hearing of universities investing in studying the gut microbiome and using that knowledge to create a clinic to evaluate and treat patients based on this research.

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References

1. Gravina A, Federico A, Ruocco E, et al. Helicobacter pylori infection but not small intestinal bacterial overgrowth may play a pathogenic role in rosacea. United European Gastroenterol J. 2015;3(1):17-24.

2. Wong F, Rayner-Hartley E, Byrne MF. Extraintestinal manifestations of Helicobacter pylori: a concise review. World J Gastroenterol. 2014;20(34):11950-11961.

3. Woo YR, Lim JH, Cho DH, Park HJ. Rosacea: molecular mechanisms and management of a chronic cutaneous inflammatory condition. Int J Mol Sci. 2016;17(9):1562.

4. Lazaridou E, Korfitis C, Kemanetzi C, et al. Rosacea and Helicobacter pylori: links and risks. Clin Cosmet Investig Dermatol. 2017; 10(10):305-310.

Researchers completed a post hoc analysis of 2 identically designed phase 3 trials to evaluate the efficacy, safety, and tolerability of once-daily dapsone gel, 7.5% for facial acne.

Once-daily dapsone gel, 7.5% is tolerable and effective for the treatment of facial acne in both men and women regardless of baseline lesion count, according to a study published in the Journal of Drugs in Dermatology.

Researchers completed a post hoc analysis of 2 identically designed phase 3 trials to evaluate the efficacy, safety, and tolerability of once-daily dapsone gel, 7.5% when used on facial acne with inflammatory and comedonal lesions. Both trials were 12-week, double-blind randomized studies (Clinicaltrials.gov Identifier: NCT01974141 and NCT01974323). Patients in the treatment arm used dapsone gel on the acne-affected areas once daily, whereas the patients in the control arm applied a vehicle to acne-affected areas oncedaily.

At baseline, patients were categorized into a low lesion count subgroup (50-74), medium lesion count subgroup (75-99), or high lesion count subgroup (≥100). Efficacy was measured by a reduction in the total, inflammatory, and comedonal lesions from baseline to the 12-week follow-up; safety was measured by the incidence of treatment-related adverse events; and tolerability was assessed by rating scales from both patients and clinicians.

Of the 4340 patients enrolled in both trials, 56% were women and 2160 patients were randomly assigned to the treatment arm. At baseline, 1239 patients were in the low lesion count subgroup, 640 patients were in the medium lesion count subgroup, and 281 patients were in the high lesion count subgroup.

Overall, women showed significant improvement of 56.07% in the low lesion count subgroup, 50.22% in the medium lesion count subgroup, and 47.63% in the high lesion count subgroup. Men, on the other hand, had improvements of 47.95%, 42.30%, and 34.68%, respectively.

In regards to inflammatory lesion count, there was a significant improvement among of 60.96% among women in the low lesion count subgroup, 57.91% in the medium lesion count subgroup, and 55.83% in the high lesion count subgroup. Men showed improvements of 52.75%, 46.85%, and 44.70%, respectively.

Regarding comedonal lesion count, women again had a significant improvement over men, with an improvement of 52.96% in the low lesion count subgroup, of 45.40% in the medium lesion count subgroup, and of 44.22% in the high lesion count subgroup compared with 44.67%, 39.38%, and 29.89% among men.

The incidence of treatment-related adverse events was low (18.3%), with the most commonly reported events being nasopharyngitis, headache, upper respiratory tract infection, and application site dryness and pruritus. Burning and stinging were reported by 27.5% of women and 30.3% of men and clinicians reported dryness in 19.6% of women and 15.9% of men, scaling in 16.1% of women and 12.9% of men, and erythema in 25.6% of women and 24.7% of men.

Future studies need to include comparable numbers of men and women and evaluate the relationship between the ratio of comedonal to inflammatory lesions and total lesions.

The researchers concluded “[d]apsone gel, 7.5% was shown to be safe, well tolerated, and effective in this population of females and males with acne, regardless of their baseline total lesion count” with women experiencing the greatest improvement.

Disclosure: This study was supported by Allergan plc. Please refer to reference for a complete list of authors’ disclosures.

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Reference

Tanghetti EA, Harper J, Baldwin HE, Kircik LH, Bai Z, Alvandi N. Once-daily topical dapsone gel, 7.5%: effective for acne vulgaris regardless of baseline lesion count, with superior efficacy in females. J Drugs Dermatol. 2018;17(11):1192-1198.

The proportion of participants achieving the primary efficacy endpoint was significantly greater in the oxymetazoline group vs the vehicle group in both trial 1 and trial 2.

Oxymetazoline reduces moderate to severe persistent facial erythema associated with rosacea and is well-tolerated by users, according to a recent study published in the Journal of Drug in Dermatology.

In this study, the researchers conducted a pooled analysis of data from 2 vehicle-controlled, multicenter, double-blind, parallel-group, phase 3 trials (REVEAL; ClinicalTrials.gov Identifier: NCT02131636 and NCT02132117) conducted in the United States from 2014 to 2015.

Study participants (N=885 [440 from trial 1 and 445 from trial 2]) included adults aged 18 and older with moderate to severe persistent facial erythema of rosacea, of which 78.8% were women. Patients were randomly assigned to oxymetazoline or vehicle, which was applied topically to the face once a day for 29 days. Moderate to severe persistent facial erythema of rosacea was defined as a grade 3 or 4 on the Clinician Erythema Assessment (CEA) scale with a photonumeric guide and Subject Self-Assessment for rosacea facial redness (SSA) scale with a photo guide.

The efficacy of oxymetazoline was assessed during each clinic visit during treatment and post-treatment. Primary efficacy assessments were a ≥2-grade decrease (composite success) from baseline on both the CEA and SSA (composite score) at 3, 6, 9, and 12 hours post-dose on day 29. Secondary efficacy assessments were the proportions of patients with a ≥2-grade decrease from baseline on the individual CEA and SSA components, and digital analysis of the percent change from baseline in facial erythema at hours 3, 6, 9, and 12 on day 29.

Most participants (96.3%, 852 participants) completed the trials. The proportion of participants achieving the primary efficacy endpoint was significantly greater in the oxymetazoline group vs the vehicle group in both trial 1 and trial 2 (trial 1, P >.001; trial 2, P =.001). When pooled, the proportion of patients in the in the oxymetazoline group achieving ≥2-grade composite success on both CEA and SSA at hours 3, 6, 9, and 12 on day 29 was 13.1%, 14.4%, 16.6%, and 13.6%, respectively (P ≤.001 for each time point). Respective values in the vehicle group were 6.5%, 6.5%, 7.3%, and 6.0% (P ≤0.001 for each time point). Significantly more patients had ≥2-grade improvement from baseline over the 12-hour observation period on the CEA at day 29 (oxymetazoline group: 390 patients or 87.6%; vehicle group: 395 patients or 90.0%).

The researchers discussed one primary limitation to the 2 trials, which was its short-term treatment period despite the fact that oxymetazoline is a long-term therapy for facial erythema. Despite this limitation, the researchers highlighted the fact that oxymetazoline therapy achieved greater efficacy than and equal tolerability to the vehicle therapy. “Oxymetazoline cream 1.0% applied topically to the face once daily for 29 days effectively reduced moderate to severe erythema of rosacea and was well tolerated,” said the researchers.

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to reference for a complete list of authors’ disclosures.

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Reference

Stein-Gold L, Kircik LH, Draelos ZD, et al. Topical oxymetazoline cream 1.0% for persistent facial erythema associated with rosacea: Pooled analysis of the two phase 3, 29-day, randomized, controlled REVEAL trials. J Drugs Dermatol. 2018;17(11):1201–1208.

The popular Keto diet, which focuses on strict carbohydrate limitations and high-fat intake, was ranked at #38

The Mediterranean diet was ranked as the best diet overall for 2019, according to new rankings released by US News and World Report.

An expert panel assessed 41 diets to come up with their final results, examining the evidence behind each diet’s claims, the short-term and long-term weight loss associated with the diet, how easy the diet is to follow, how well each diet conforms to current nutrition standards, and its effect on diabetes and cardiovascular disease prevention.

Diets that rounded out the top 5 spots included the DASH (Dietary Approaches to Stop Hypertension) diet (#2), the Flexitarian diet (a mostly vegetarian diet; #3), the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet (tied for #4), and the Weight Watchers diet (tied for #4).

The popular Keto diet, which focuses on strict carbohydrate limitations and high-fat intake, was ranked at #38, with some experts noting that it could lead to nutritional imbalances and may require medical supervision. Other diets that made the bottom of the list included Whole30 diet (tied for #38), the Body Reset diet (#40), and the Dukan diet (#41), which the experts thought was too restrictive and was not backed by any efficacy evidence.

As for diabetes prevention and management, the Mediterranean diet (#1), DASH diet (tied for #2), Flexitarian diet (tied for #2), Mayo Clinic diet (tied for #2), and Volumetrics (tied for #2) were at the top of the list, while the Mediterranean diet (tied for #1), Ornish diet (tied for #1), and DASH diet (#3) were voted best heart-healthy diets.

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For more information visit USnews.com.

Results showed that HS prevalence was increased in patients with psoriasis when compared with the control participants.

There is a significant positive correlation between psoriasis and hidradenitis suppurativa (HS), according to study results recently published in the Journal of the American Academy of Dermatology. The findings of the large-scale study support previous case reports and smaller studies that similarly note the coexistence of psoriasis and HS. 

Investigators completed a cross-sectional population-based study to compare the prevalence of HS in patients with psoriasis across age-, sex-, and ethnicity-matched controls. The study included 68,836 patients with psoriasis and 68,836 control participants.  

Results showed that HS prevalence was increased in patients with psoriasis when compared with the control participants (0.3% vs 0.2% respectively; odds ratio [OR] 1.8; 95% CI, 1.5-2.3; P <.001). When investigators adjusted for smoking, obesity, and other comorbidities in a multivariate analysis, the relationship persisted (OR 1.8; 95% CI 1.4-2.2; P <.001).

Compared with patients with psoriasis alone, those with a dual diagnosis of psoriasis and HS were younger (39.0 ± 15.7 vs 42.6 ± 21.2 years; P =.015), more likely to be obese (35.1% vs 25.3%; P =.001), and were smokers (58.5% vs 37.3%; P <.001). 

Study limitations include a lack of data related to clinical features and severity of both psoriasis and HS. In addition, the classification of socioeconomic status was based on a poverty index rather than household income. Finally, the study was limited to Israeli patients and further longitudinal observational studies are necessary to confirm these findings in other populations. 

Results of the study suggest that physicians treating patients with psoriasis should be mindful of the association between psoriasis and HS, and be aware that systematic therapies that treat both conditions may be preferable in patients with a dual diagnosis. 

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Reference

Kridin K, Shani M, Schonmann Y, et al. Psoriasis and hidradenitis suppurativa: a large-scale population-based study [published online November 28, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.11.036

Clindamycin as monotherapy may be a useful and safe alternative to combination clindamycin and rifampicin treatment for hidradenitis suppurativa.

Clindamycin monotherapy may be as or more effective than dual antibiotic treatment for hidradenitis suppurativa (HS) regardless of clinical stage, according to research published in the Journal of the American Academy of Dermatology.

A cohort (N=60) of men and women ≥18 years of age with clinical and sonographic criteria of HS and total abscesses and inflammatory nodule ≥3 at baseline were divided into 2 treatment groups. For a total of 8 weeks, Group A (n=30) was treated with oral clindamycin 150 mg 4 times daily and oral rifampicin 300 mg twice daily; Group B (n=30) was treated with oral clindamycin 150 mg 4 times daily. Researchers performed Power Doppler ultrasound (PD-US) examinations on all patients at baseline and at week 8. The Pulse Repetition Frequency, the Time Gain Compensation, and the Volumetric Image Acquisition were kept constant to reduce PD-US observation limits and statistical mistakes. Researchers analyzed the lesional type of involvement (nodule, abscess, draining tunnel), lesion location, maximum diameter (mm) of the lesion, draining tunnel’s thickness, and presence of vascularization from the sonographic data.

Statistical analysis showed equivalence between the mono and combination therapy groups, with a significant improvement in disease activity found in both groups (P =.598) as assessed by Hidradenitis Suppurativa Clinical Response, International Hidradenitis Suppurativa Severity Score System, PD-US, Pain Visual Analogue Scale, and Dermatology Life Quality Index. Group B had a significantly greater decrease in Pain Visual Analogue Scale (P =.038) and Dermatology Life Quality Index (P =.037) compared with Group A. The count reduction of nodules (P =.517) and of abscesses (P =.938) was not statistically different between the groups. The number of reduced draining tunnels “was statistically more elevated in Group B than in Group A (P =.002),” the researchers noted.

The investigators speculated that “consequent lower clindamycin levels in combined protocols may reduce the strength of the treatment itself in severe HS lesion, as draining tunnels are commonly colonized by polymorph-abundant anaerobic microflora.” The fact that this study was not randomized or placebo-controlled contributes to limitations of the findings.

The researchers concluded that clindamycin as monotherapy may be a useful and safe alternative to combination clindamycin and rifampicin treatment but suggest that “[p]rospective randomized controlled trials are needed to confirm the results of this study.”

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Reference

Caposiena Caro RD, Cannizzaro MV, Botti E, et al. Clindamycin versus clindamycin plus rifampicin in hidradenitis suppurativa treatment: clinical and ultrasound observations [published online November 28, 2018]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2018.11.035