The addition of hyperbaric oxygen to antibiotic treatment improved many clinical scores in patients with hydranitis suppurativa

Clinical bottom line:

1. Both groups improved over the course of treatment.

2. Patients with adjunctive HBOT had more chance of normalising ESR but not CRP after 10 weeks, as well as improvement in most scores assessed.
Citation/s: 1. Yildiz H, Senol L, Ercan E, Bilgili ME, Karabudak Abuaf O. A prospective randomized controlled trial assessing the efficacy of adjunctive hyperbaric oxygen therapy in the treatment of hidradenitis suppurativa. International journal of dermatology. 2016;55(2):232-7.

Lead author's name and fax: Hamda Yildiz hamzayildiz@gmail.com
Three-part Clinical Question: For patients with hidradenitis suppurativa, does the addition of HBO to a regimen of antibiotics only, improve the rate of healing?

Search Terms: hydradenitis suppurativa, wound healing,
The Study: Non-blinded open randomised controlled trial with intention-to-treat.

The Study Patients: Adult patients newly diagnosed with hydradenitis suppurative (HS)

Control group (N = 21; 21 analysed): 10 weeks of double therapy with clindamycin (300 mg bd) and rifampicin 300 mg bd).

Experimental group (N = 22; 22 analysed): As above plus 100% oxygen for 120 mins at 2.4 ATA daily, Monday to Friday to a total of 20 treatments over four weeks.


The Evidence:
Outcome
Time to Outcome
Control Rate
HBO Rate
Relative risk reduction
Absolute risk reduction
NNT
ESR normalised from start to 10 weeks
10 weeks
0.81
1.0
23%
0.19
5
95% CI:
3% to 44%
-.02 to 0.39
3 to 45
CRP normalised from start to week 10
10 weeks
0.67
.73
9%
0.06
-17
95% CI:
-32% to 50%
-0.21 to 0.33
NNT = 3 to INF;
NNH = 5 to INF
Dermatological Life Quality Index >50% improved
10 weeks
.62
1.0
61%
0.38
-3
95% CI:
27% to 95%
0.17 to 0.59
2 to 6
Comments:

1. Small open trial subject to bias for clinical score outcomes

2. Not clear that all patients received the appropriate supportive care such as help to stop smoking and to lose weight.

3. Control patients had longer period of illness (7 years on average versus 11 years) and this may have biased results to the HBOT group.


Appraised by: Michael Bennett Tuesday, 17 January 2017

Email: m.bennett@unsw.edu.,au ;

Kill or Update By: January 2020



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