LAUSR

planin (dalbavancin is not routinely evaluated) and given the isolated flora, we decided to undertake therapy with dalbavancin (a single intravenous dose of 1,500 mg with a slow infusion over at least 30 minutes during 48 hours of hospitalization). This induced rapid reduction of inflammatory nodules and resolution of the signs of cutaneous inflammation. In addition, after 48 hours, the CRP level (0.6 mg/dL) and ESR (71 mm/h) decreased. The therapeutic effect continued over subsequent weeks, resulting in almost complete resolution of the inflammatory nodules and draining tunnels after four weeks and a dramatic improvement in quality of life (IHS4: 22; PAIN VAS:1; DLQI: 3) (figure 1). CRP and ESR levels showed a continuous decline. Mild nausea that rapidly resolved, related to infusion, was reported. We reassessed the patient at three and six months, and he was considered to be disease-free at 22 weeks. The patient subsequently reported re-activation of a pubic lesion, although in a contained form, which resolved with resorcinol 15% cream, once/daily. Dalbavancin is a semisynthetic molecule derived from a glycopeptide, which is approved exclusively for the treatment of acute bacterial skin infections sustained by Gram-positive bacteria, including methicillin-resistant and methicillin-sensitive Staphylococcus aureus, Streptococcus pyogenes, Streptococcus agalactiae, and Enterococcus faecalis [7]. These bacteria have been strongly associated with the microbiome in HS patients, which is also composed, to a lesser extent, of Gram-negative and anaerobic bacteria [2, 4]. Given the growing data on resistance rates, antibiotics for HS should be administrated when clinically indispensable and primarily for antimicrobial motives, targeting precisely the isolated sensitive bacteria (as in our case, when biological therapy was not sufficient to contain the disease flares underlying bacterial superinfections). Dalbavancin has an excellent safety profile [8]. The most frequent adverse events are infusion-related effects (pruritus, flushing), gastrointestinal disorders (nausea, diarrhoea), and headache [9]. As a minimally invasive treatment with a high level of patient satisfaction, targeting skin infections with a reduced risk of increased bacterial resistance, dalbavancin appears to be a promising treatment for late-stage HS with predominantly isolated Gram-positive bacterial strains. Prospective and randomized controlled studies are needed to verify the efficacy of dalbavancin for HS and to further elucidate the role (including the potential immunomodulatory and anti-inflammatory effects) of this antibiotic in the disease. Acknowledgements and disclosures. Acknowledgements: none. Funding sources: none. Conflicts of interest: none.