# Hidradenitis suppurativa (Hurley stage I/II) - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: European HS Guidelines (EHSF) · BAD Guidelines for Hidradenitis Suppurativa · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) - Verified date: 2026-08 ## Verified against - European HS Guidelines (EHSF) - Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) ## Treatment metadata - Clindamycin — topical - Doxycycline — 100 mg — oral.solid - Rifampicin — 300 mg — oral.solid ## Complete treatment card ```text HIDRADENITIS SUPPURATIVA (HURLEY STAGE I/II) Sources: European HS Guidelines (EHSF) · BAD Guidelines for Hidradenitis Suppurativa · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Burning, stinging, pain, itching, warmth, or excess sweating can precede a nodule by 12 to 48 hours in about half of patients [itching · sweating] - Flares are commonly triggered by menstrual periods, weight gain, stress, hormone shifts, heat, or sweating [sweating · weight gain] - Onset typically falls between puberty and young adulthood, with lesions recurring and periods of partial improvement - A relative with a similar skin condition supports the diagnosis - Nodules can discharge blood-tinged fluid that turns thick and foul-smelling over time - It costs the patient socially - through the pain, the sensitive sites, the discharge, the smell, the disfigurement and the scarring - and a late diagnosis only makes that worse [scarring] SIGNS - what you find (10) - Deep nodules half a centimeter to two centimeters wide, lasting days to months, are the hallmark lesion - Unlike simple boils, these lesions run deep, recur, rupture, and link into connecting tracts that can ulcerate or drain - Patients generally look well and are not febrile unless there is secondary infection or advanced disease - The armpit is the single most common site of disease - The scalp and area behind the ears are only occasionally involved - Hurley stage 1 disease shows abscesses without tunnels or scarring - Hurley stage 2 disease shows recurrent abscesses with tunnels and scarring, either as a single lesion or several widely spaced ones [scarring] - Hurley stage 3 disease is diffuse, with multiple interconnected tracts and large involved areas leaving little normal skin - Beyond the armpit the sites are the groin, the perianal and the perineal skin, and under the breast - the places where skin folds on skin - The full lesion set is deep nodules and abscesses, draining tunnels through the skin - sinus tracts or fistulae - and fibrotic scars [fistula · scarring] TESTS (6) - No blood tests or biopsies are required to make the diagnosis; it is based on clinical findings - A skin biopsy can be used to exclude squamous cell carcinoma when the diagnosis is unclear - Swabbing for bacterial culture only adds value if a secondary infection or another diagnosis is suspected - Ultrasound is not routinely needed but can map tunnels before surgery - MRI may be used for severe perianal disease - Because of linked comorbidities, guidelines call for yearly exams, validated screening tools, and lab work IF NOT THIS - what else fits (9) - Folliculitis, furuncles, and carbuncles (follicular pyoderma) are on the differential - Noduloulcerative syphilis is on the differential - Lymphogranuloma venereum is on the differential - Epidermoid, dermoid, pilonidal, or Bartholin cysts are on the differential - Perianal involvement raises the possibility of Crohn disease instead - Granulomatous conditions such as Crohn disease, sarcoidosis, or mycobacterial infection can look similar under the microscope - Chronic deep folliculitis shares similar histopathology and belongs on the differential - Langerhans cell histiocytosis shares similar histopathology and belongs on the differential - Folliculotropic mycosis fungoides shares similar histopathology and belongs on the differential Source StatPearls "Hidradenitis Suppurativa" - disease-level clinical article Status traced to the source above Rx: Localised disease | Widespread disease | Main treatment LOCALISED DISEASE 1. CLINDAMYCIN [1st line] Adult Apply 1% topical solution or lotion twice daily to affected axillary/inguinal lesions x 12 weeks Peds Adolescents >=12 years: apply twice daily to affected regions Source European HS Guidelines (EHSF) Why Topical lincosamide antibiotic with anti-inflammatory as well as antibacterial activity, applied to affected axillary and inguinal lesions in early-stage hidradenitis suppurativa to reduce local bacterial load and inflammation. Caution There is a risk of pseudomembranous colitis even with topical application (rare); stop if severe diarrhea develops. Skin dryness and irritation can occur at the application site. Egypt CLINDACINE RAMEDA 1% TOPICAL GEL 20 GM RAMEDA 7.00 EGP CLINOCID 1% TOPICAL CREAM 30 GM CID 7.00 EGP CLINDASOL 1% TOPICAL GEL 20 GM AMRIYA > EURO... 26.00 EGP WIDESPREAD DISEASE 2. DOXYCYCLINE [1st line] Adult 100 mg twice daily (or 100 mg once daily) x 12 weeks Peds Use under 8 years only for a severe or potentially life-threatening infection, or where no better alternative exists - the risk is permanent tooth discoloration and enamel hypoplasia during tooth development. Where it is justified: 2.2 mg/kg every 12 hours, maximum 100 mg per dose. Source Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) Why Anti-inflammatory and immunomodulatory oral agent for widespread Hurley I/II lesions Caution Do not take immediately before lying down (esophagitis risk). Contraindicated in pregnancy. There is a photosensitivity risk, so wear sunscreen. Egypt FARCODOXIN 100MG 10 CAPS. PHARCO 11.00 EGP (1.10/unit) DOXY M.R.100 MG 10 CAPS. ADWIA 12.00 EGP (1.20/unit) GRANUDOXY 100MG 10 F.C. TAB. GLOBAL NAPI P... 12.00 EGP (1.20/unit) DOXYDOX 100 MG 10 CAPS. EIPICO 23.00 EGP (2.30/unit) DOXYMYCIN 100 MG 10 CAPS. EL NILE. 30.00 EGP (3.00/unit) TABOCINE 100MG 10 CAPS. TABUK PHARMAC... 46.00 EGP (4.60/unit) VIBRAMYCIN 100MG 10 CAPS. PFIZER 65.00 EGP (6.50/unit) MAIN TREATMENT - give alongside 3. RIFAMPICIN [add-on - not a substitute] Adult 300 mg twice daily combined with oral Clindamycin 300 mg twice daily x 10-12 weeks Peds Specialist pediatric dermatology referral required Source European HS Guidelines (EHSF) Why Combination therapy reserved for refractory Hurley II disease under specialist dermatology supervision Caution Rifampicin causes orange-red discoloration of body fluids (urine, sweat, tears, contact lenses). Rifampicin is a potent CYP450 enzyme inducer; it renders oral contraceptives INEFFECTIVE (must use barrier contraception). There is a hepatotoxicity risk, so monitor LFTs. Egypt RIFAMPIN 300MG 10 CAPS. ARAB CAPS 8.00 EGP (0.80/unit) RIFABIOTIC 300 MG 8 CAPS. CID 8.00 EGP (1.00/unit) RIFAMPICIN 300MG 8 CAPS. EL NASR 9.50 EGP (1.19/unit) RIFAMPIN 300MG 8 CAPS (MISR) MISR 9.50 EGP (1.19/unit) RIMACTANE 300MG 8 CAPS. NOVARTIS 10.10 EGP (1.26/unit) RIFAMPIN 300MG 10 CAPS. (DEBEIKY) DEBEIKY 38.50 EGP (3.85/unit) RIFACTINE 300 MG 8 CAPS. MUP 31.00 EGP (3.88/unit) RIFAMOX 100MG/5ML 30GM SUSP. EL NASR 4.50 EGP -> ? strength differs, ? different route - not oral solid RIFAM 100MG/5ML 60ML SUSP. PHARCO 7.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)