Doxycycline and Clindamycin Gel

We often use oral doxycycline and topical clindamycin gel for treating the incision after a cleft lift in patients with known or suspected hidradinitis suppuritiva (HS)

It is not unusual for us to see patients with both pilonidal disease and hidradinitis suppuritiva (HS). When this combination of problems occurs, the HS can adversely effect the healing of a cleft lift procedure. In order to try to prevent wound healing problems, there are some strategies that we use to try to minimize these problems. Of course, it is important to follow our usual activity, dressings, and nutrition instructions.

We always prescribe post operative antibiotics, but these are targeted toward the kind of bacteria that are usually involved with pilonidal disease. In patients with HS, there are other types of bacteria involved, and therefore different antibiotics are used to treat HS. The most common antibiotics used are doxycycline and clindamycin. With HS the body can attack the normal types of bacteria in the skin and incision, and the doxycycline and clindamycin attempt to decrease the number of these specific bacteria to prevent damage from the HS reaction.

Our protocol to prevent problems consists of having patients take oral doxycycline 100mg twice daily for six weeks after finishing the post operative pilonidal targeted antibiotics, and applying clindamycin gel or lotion to the lower 2″ of the incision starting one week after surgery. If problems do develop, the topical clindamycin can be put anywhere on the incision that develops any degree of separation. The gel or lotion should be applied directly on the incision, and then gauze tucked into the crease to allow air circulation. If you can let the medication dry for a few minutes before placing the gauze, this will keep it from being immediately wiped away. This combination has been effective in controlling wound problems in some patients.

If in spite of this, there is wound separation that does not seem to be responding to these antibiotics, we usually will want to get dermatology involved in evaluating and treating the HS more aggressively. At times a biologic medication, like Humira or Cosentyx, will be needed to get things under control.

HS can attack incisions in the gluteal area any time after surgery, and this is a very frustrating problem. However, we do our best to try to understand the problems that the combination of these two diseases cause, and get things to heal. Here is more information about pilonidal disease and HS.