Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects
Affected areas may include:
- upper thighs
The painful lesions of HS may also fill with an unpleasant-smelling fluid that can leak without warning.
There’s currently no cure for HS. However, there are a wide variety of medical and surgical options to help you manage your symptoms, according to recent clinical guidelines from the United States and Canadian Hidradenitis Suppurativa Foundations.
If you’re living with HS, it’s helpful to be aware of all the treatment options available so you can find the best one for you.
Read on to learn about the different types of HS treatments and how they work.
A topical treatment is something that you use directly on your skin. Topical treatments can come in a variety of forms, including lotions, ointments, and creams.
Depending on the product, topical treatments can work to cleanse the affected area, ease irritation, or aid in lesion healing. Topical treatments for HS are typically products such as antiseptic agents or acne treatments. Some examples are:
- zinc pyrithione
- resorcinol cream, 15%
The above topical treatments may be used for mild to moderate HS. While they don’t actively treat what’s causing the condition, they can help to ease some of its symptoms.
Antibiotics can also be used topically for the treatment of HS. Topical clindamycin (Cleocin T, Clinda-Derm) is considered to be the
Topical treatments may cause skin irritation. This can include symptoms such as redness, itching, or a burning sensation.
Topical and oral antibiotics can be used to treat HS.
Topical antibiotics, such as clindamycin (Cleocin T, Clinda-Derm), are commonly prescribed for mild HS. They can treat infections, reduce inflammation, and prevent new lesions from forming.
They may also reduce the odors that can sometimes accompany infection.
A typical course of treatment with topical antibiotics might involve applying lotion to your HS lesions twice a day. The duration of such treatment varies from person to person.
Side effects of topical antibiotics can include a mild burning sensation and the risk of antibiotic resistance.
Oral antibiotics can be prescribed for mild disease. However, they’re typically used in moderate to severe HS cases or when topical treatment hasn’t been effective.
Like topical antibiotics, these drugs help to treat infection and manage inflammation.
Oral antibiotics used to treat infections caused by HS include:
- tetracycline antibiotics
- metronidazole (Flagyl)
- moxifloxacin (Avelox)
- rifampin (Rimactane)
They’re often taken by mouth for 7 to 10 days. Some cases may require longer periods of treatment. Depending on the severity of your condition, you may receive one antibiotic or multiple antibiotics.
Side effects of oral antibiotics can include diarrhea, Clostridium difficile bacterial infection, and rust-yellow to brown discoloration of urine.
HS-related pain can come from a variety of sources, including lesions, abscesses, and scarring. This makes pain management an important aspect of HS treatment.
The pain associated with HS can be diverse in nature. For example, it can be either acute or chronic as well as either inflammatory or noninflammatory.
Pain medications that might be used include:
- lidocaine (Ztlido)
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- acetaminophen (Tylenol)
Topical pain medications such as lidocaine may sometimes be used to treat acute HS pain. These can be applied directly to the affected area.
Oral pain medications are generally preferred for managing pain associated with HS. First-line pain medications include acetaminophen and NSAIDs, such as ibuprofen (Advil, Aleve) and naproxen (Naprosyn).
If first-line pain medications aren’t effective, a short-term course of opioids may be prescribed. The opioid tramadol (ConZip, Ultram) can be used as an alternative to traditional opioids such as codeine and morphine.
Additionally, some anticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica), may be effective at relieving neuropathic pain.
A variety of side effects are associated with various pain medications. Examples can include stomach upset, nausea and vomiting, and constipation. Use of opioids also carries the risk of addiction.
Corticosteroids can also be used to decrease swelling, reduce inflammation, and manage pain. They can be administered through injection or orally.
Injected corticosteroids, also called intralesional corticosteroids, can be used in mild cases. The injection is made directly at the affected area and can help to ease pain and swelling.
Oral corticosteroids are used for more moderate to severe cases. When taken orally, corticosteroids can affect the whole body. This can help to clear existing HS lesions and prevent new ones from forming.
A short-term course of oral corticosteroids can be used to manage a flare-up of symptoms.
Longer-term oral corticosteroids can also be used in severe HS cases that aren’t responding to standard treatments. However, in these cases, the lowest dose possible should be prescribed.
Injected corticosteroids can lead to pain near the injection site, facial flushing, and insomnia.
Some potential side effects of oral corticosteroids are high blood pressure, weight gain, and mood changes. Long-term use may lead to thinning skin, high blood sugar, and osteoporosis.
HS is thought to be influenced by hormones called androgens. Hormonal changes, such as during the menstrual cycle and pregnancy, may worsen HS symptoms.
Because of the effect of hormones on HS, your doctor may recommend hormone therapy as a potential treatment option. Hormone therapy may help to decrease pain and reduce the amount of fluid draining from HS lesions during a flare-up.
Hormone therapy for HS could involve taking the following types of medications:
- oral contraceptives containing estrogen
- spironolactone (Aldactone)
- finasteride (Propecia, Proscar)
- metformin (Glumetza)
Hormone therapy for HS can be taken orally. It may be used as the only therapy (monotherapy) for mild to moderate HS. In severe cases, it can be used in combination with other treatments.
Use of oral contraceptives that only contain progestin is typically avoided. This is because there’s some anecdotal evidence that HS may get worse when using this type of medication.
Side effects of hormone therapy in women can include blood clots if taken during pregnancy. Men may experience decreased libido and problems ejaculating.
In rare cases, men and women could develop breast tumors as a side effect.
Retinoids are medications derived from vitamin A. They work by slowing down the growth of skin cells and can reduce inflammation. Retinoids can be used to treat a variety of inflammatory skin conditions, including acne and psoriasis.
Oral retinoids may be helpful for some individuals with HS. If you’re prescribed an oral retinoid for your HS, it will likely be one of these:
- isotretinoin (Amnesteem, Claravis)
- acitretin (Soriatane)
Oral retinoids are generally only recommended as a second- or third-line treatment for HS. They may also be prescribed if severe acne occurs along with HS lesions.
Oral retinoids shouldn’t be taken during pregnancy, as they may lead to severe birth defects. Other potential side effects include dry skin, cracked lips, and temporary hair loss.
For more severe cases of HS that don’t respond to antibiotics or hormone therapy, biologic drugs may be an option. Biologics help your body fight HS by targeting the parts of your immune system that stimulate inflammation.
Biologics are administered via injection or an intravenous (IV) infusion. They’re usually taken on a weekly basis and can be administered at home or at a hospital or clinic by a medical professional.
The only HS treatment that’s approved by the Food and Drug Administration (FDA), and the one with the strongest evidence for use, is adalimumab (Humira). This biologic has been approved to treat moderate to severe HS.
Other biologics, such as infliximab (Remicade) and anakinra (Kineret), may also be effective at treating HS.
Side effects can include:
- pain near the injection site
- difficulty breathing
- low blood pressure
- increased risk of infections
If you experience infections, your doctor will likely discontinue use of biologics and explore other treatment options.
Rare but serious side effects can include autoimmune nerve symptoms and heart failure. Biologics can also cause an increased risk of lymphoma. Speak with your doctor about the benefits and risks of this treatment.
Several energy sources may be considered to help treat HS. These are typically used for moderate to severe HS but can also be used for mild cases.
One of these techniques involves using a laser to treat active lesions. The energy from the laser can destroy hair follicles, helping to clear HS lesions. This type of therapy may involve three to four laser treatment sessions.
Photodynamic therapy uses drugs called photosensitizers and a light source to kill abnormal cells. Photosensitizing drugs are applied topically or injected at the lesions. The HS cells then absorb this drug. When the light source is turned on, the drug reacts with the cells and causes them to die.
Radiation treatment has also been used to treat HS and may lead to improvement in some individuals. However, since it involves exposing your body to radiation, your doctor will likely recommend other treatments first.
It’s possible that you’ll feel some discomfort during these procedures. Other potential side effects that you may experience afterward can include temporary discomfort, redness, or swelling in the treated area.
A variety of surgical options are available for the treatment of HS, ranging from minor incisions to the complete removal of the skin affected by lesions.
Whether you’re eligible for HS surgery depends on the severity of your HS and how well you respond to other forms of treatment.
People who have severe HS that hasn’t responded to other types of treatment are good candidates for surgery. The symptoms of severe HS can include:
- widespread lesions or abscesses
- many connecting tunnels under the skin
Some of the surgical techniques that may be used include:
- Deroofing: The surgeon removes the tissue above tunnels or abscesses, allowing the exposed area to heal. This method is typically used for recurring lesions or tunnels.
- Excision: The surgeon removes the lesion and some of the surrounding healthy skin. This can be accomplished with a scalpel, laser, or electrosurgical tool. It’s used for extensive, recurring lesions.
- Excision and drainage: The surgeon drains one or two lesions and then removes them. This is only recommended to provide short-term relief for abscessed lesions.
If you think you might be a good candidate for surgery, talk to your doctor about which option might be right for you.
Some of the potential side effects of surgery for HS include scarring or infection at the surgical site. Additionally, surgery only treats a specific area, so lesions may appear at new locations.
Wound care following surgery for HS is also very important. Your doctor will choose an appropriate dressing based on the location and extent of the surgery. They may also recommended using an antiseptic wash during healing.
When caring for a wound after surgery for HS, it’s important to follow general best practices for wound care, including:
- always washing your hands before touching the area
- avoiding clothes that may rub on the wound
- following your doctor’s instructions regarding when and how often to clean your wound or change its dressing
- carefully watching for signs of a potential infection
There are a few natural treatments and lifestyle modifications that may help with your HS.
Smoking cigarettes and being above average weight have been
Additionally, there are some activities that may further irritate your skin. You may find it helpful to avoid doing the following things at or around the affected area:
- wearing tight or restrictive clothing
- cleaning with harsh tools, such as brushes or washcloths
- using adhesive bandages
- utilizing products that may contain irritants, such as detergents or perfumes
There’s also some indication that dietary supplementation, particularly with zinc, may help people with mild to moderate HS. Because of this, your doctor may recommend oral zinc supplements. Don’t overdo it, though — too much zinc can cause an upset stomach.
Avoiding foods that contain dairy or brewer’s yeast may help some people with HS. However, more research is needed to support this.
There are many potential treatments for HS, each with its own benefits and possible side effects. Which treatment (or treatments) may be recommended to you will depend on the severity of your condition.
It’s important to thoroughly discuss your treatment options with your doctor or dermatologist. Be sure to let them know if you experience any side effects during treatment and also if you’re open to trying out any new treatments. Working together can help you to manage your HS.