Dawaa Reference

chronic

Hidradenitis suppurativa (Hurley stage I/II)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

European HS Guidelines (EHSF) · BAD Guidelines for Hidradenitis Suppurativa · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)

Verified against2 documents
  • European HS Guidelines (EHSF)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)

Verified date2026-08

Presentation reference

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

SourceStatPearls "Hidradenitis Suppurativa" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Localised disease | Widespread disease | Main treatment

LOCALISED DISEASE

1

CLINDAMYCIN

Localised disease

1st line

Formtopical

Adult dose and duration

Apply 1% topical solution or lotion twice daily to affected axillary/inguinal lesions x 12 weeks

Paediatric dose
Dose by age
Adolescents >=12 years:apply twice daily to affected regions
Dose 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.

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
CLINDACINE RAMEDA 1% TOPICAL GEL 20 GMRAMEDA7.00 EGP
CLINOCID 1% TOPICAL CREAM 30 GMCID7.00 EGP
CLINDASOL 1% TOPICAL GEL 20 GMAMRIYA > EUROPEAN EGYPTIAN PHARM. IND.26.00 EGP

WIDESPREAD DISEASE

2

DOXYCYCLINE

Widespread disease

1st line

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg twice daily (or 100 mg once daily) x 12 weeks

Paediatric dose

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.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)

Why

Anti-inflammatory and immunomodulatory oral agent for widespread Hurley I/II lesions

Cautions
  • Do not take immediately before lying down (esophagitis risk).
  • Contraindicated in pregnancy.
  • There is a photosensitivity risk, so wear sunscreen.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)

MAIN TREATMENT - give alongside

3

RIFAMPICIN

add-on - not a substitute

Strength300 mg

Formoral.solid

Adult dose and duration

300 mg twice daily combined with oral Clindamycin 300 mg twice daily x 10-12 weeks

Paediatric dose

Specialist pediatric dermatology referral required

Dose source

European HS Guidelines (EHSF)

Why

Combination therapy reserved for refractory Hurley II disease under specialist dermatology supervision

Cautions
  • 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.
Egyptian brands
Egyptian brandManufacturerIndicative price
RIFAMPIN 300MG 10 CAPS.ARAB CAPS8.00 EGP (0.80/unit)
RIFABIOTIC 300 MG 8 CAPS.CID8.00 EGP (1.00/unit)
RIFAMPICIN 300MG 8 CAPS.EL NASR9.50 EGP (1.19/unit)
RIFAMPIN 300MG 8 CAPS (MISR)MISR9.50 EGP (1.19/unit)
RIMACTANE 300MG 8 CAPS.NOVARTIS10.10 EGP (1.26/unit)
RIFAMPIN 300MG 10 CAPS. (DEBEIKY)DEBEIKY38.50 EGP (3.85/unit)
RIFACTINE 300 MG 8 CAPS.MUP31.00 EGP (3.88/unit)
RIFAMOX 100MG/5ML 30GM SUSP.? strength differs? different route - not oral solidEL NASR4.50 EGP
RIFAM 100MG/5ML 60ML SUSP.? strength differs? different route - not oral solidPHARCO7.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.