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Topical resorcinol for mild-moderate hidradenitis suppurativa

Key clinical point: Topical resorcinol 15% as long-term treatment may be a safe and effective alternative to clindamycin in patients with mild-moderate hidradenitis suppurativa (HS).

Major finding: Clinical response was observed in 52.5% and 85.2% of patients with HS after 4 and 12 weeks, respectively (P less than .001). There was a significant decrease in the International Hidradenitis Suppurativa Severity Score System (IHS4) score from baseline after week 4 (P less than .001) and week 12 (P less than .05). Adverse effects were generally well tolerated.

Study details: Sixty-one patients with HS (Hurley I and II) were treated with topical resorcinol 15% once daily for 12 weeks, with assessments at baseline and after 4 and 12 weeks.

Disclosures: No source of funding was identified. The authors declared no conflicts of interest.

Commentary

“Studies evaluating the use of topical agents in the treatment of hidradenitis suppurativa are few, with no rigorous trials data available to guide management. Meanwhile, the use of topical clindamycin, the mainstay of topical antibiotic therapy in HS, may increase the risk of developing clindamycin-resistant Staphylococcus aureus.

In the study by Molinelli et al, topical resorcinol 15% cream, which is keratolytic, antimicrobial, and anti-inflammatory, emerges as an alternative, non-antibiotic option for topical management of HS. While use of resorcinol for HS has been described previously in smaller studies, for treatment of individual flaring lesions, it has not been investigated on this scale in application to all active HS lesions—including nodules, abscesses, and sinus tracts. With once daily application, the study revealed clinical response by HiSCR in the majority of patients, both at week 4 and at week 12, with few adverse effects.

It is important to acknowledge that this study was uncontrolled and does not have a comparator group. Randomized trials, with comparison to placebo and / or topical clindamycin would be necessary to validate these results. One must also acknowledge that 15% resorcinol cream is not readily available and, in the United States, must be compounded at a specialty pharmacy. Regardless, resorcinol 15% cream is a potentially attractive option in the armamentarium for mild-to-moderate, Hurley stage I or II HS, and it appears in the recently published North American clinical management guidelines for hidradenitis suppurativa.”

Robert G. Micheletti, MD

Assistant Professor of Dermatology and Medicine

Perelman School of Medicine, University of Pennsylvania

References:
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101.
Boer J, Jemec GBE. Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa. Clin Exp Dermatol. 2010;35(1):36-40.
Fischer AH, Haskin A, Okoye GA. Patterns of antimicrobial resistance in lesions of hidradenitis suppurativa. J Am Acad Dermatol. 2017 Feb;76(2):309-313.e2.
Pascual JC, Encabo B, Ruiz de Apodaca, RF, et al. Topical 15% resorcinol for hidradenitis suppurativa: An uncontrolled prospective trial with clinical and ultrasonographic follow-up. J Am Acad Dermatol. 2017;77(6):1175-8.

Citation:

E Molinelli et al. Br J Dermatol. 2020 Jun 24. doi: 10.1111/bjd.19337.