Rifampin-moxifloxacin-metronidazole combination therapy for severe Hurley Stage 1 Hidradenitis Suppurativa: prospective short-term trial and one-year follow-up in 28 consecutive patients.

Severe Hurley stage 1 Hidradenitis suppurativa (HS1) is a difficult to treat form of the disease.To assess the efficacy and tolerance of the oral combination of rifampin (10 mg/kg once daily) - moxifloxacin (400 mg once daily) - metronidazole (250 to 500 mg t.i.d) (RMoM) treatment strategy in severe HS1 patients.Prospective, open-label, non-comparative cohort study in 28 consecutive patients. 19 patients were treated for 6 weeks by RMoM, followed by 4 weeks of RMo alone, then by cotrimoxazole after remission. Moxifloxacin was replaced by pristinamycin (1g t.i.d) in 9 cases because of contra-indications or intolerance. Primary endpoint was a Sartorius score of 0 (clinical remission, CR) at week 12.

The median Sartorius score dropped from 14 to 0 (p= 6 x 10^-6) at week 12, 75% of patients reaching CR. A low initial Sartorius score was a prognosis factor for CR (p = 0.049). Main side-effects were mild gastro-intestinal discomfort, mucosal candidiasis and asthenia. At one year of follow-up, the median [IQR] number of flares dropped from 21/year to 1 (p = 10^-5).

small monocentric non-controlled study.complete and prolonged remission can be obtained in severe HS1 using targeted antimicrobial treatments.