Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects
Affected areas may include:
- inner 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 to find the best one for you.
Read on to learn about the different types of HS treatments and how they work.
Topical treatments are treatments you put directly on your skin. They can come in various 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 percent
You may use the above topical treatments 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) may be the
Topical treatments can cause skin irritation, redness, itching, or a burning sensation.
Topical and oral antibiotics 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 therapy varies from person to person.
Side effects of topical antibiotics can include a mild burning sensation and the risk of antibiotic resistance.
Oral antibiotics treat milder diseases. However, they’re effective in moderate to severe HS cases or when topical treatment has not 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)
The treatment plan can vary depending on the antibiotic used. Some cases may require more extended 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:
- Clostridium difficile bacterial infection
- yeast infection
HS-related pain can come from various sources, including lesions, abscesses, and scarring, making pain management essential for HS treatment.
The pain associated with HS can be diverse. For example, it can be acute or chronic, and inflammatory or noninflammatory.
Pain medications that might be used include:
- lidocaine (Ztlido)
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- acetaminophen (Tylenol)
Your doctor may consider topical pain medications also to treat acute HS pain. These can be applied directly to the affected area.
First-line pain medications include acetaminophen and NSAIDs, such as ibuprofen (Advil, Aleve) and naproxen (Naprosyn).
If first-line pain medications are not effective, your doctor may consider a short-term course of opioids. For example, the opioid tramadol (ConZip, Ultram) works as an alternative to traditional opioids such as codeine and morphine.
Additionally, some anticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica), effectively relieve neuropathic pain.
A variety of side effects are associated with various pain medications. Examples can include stomach upset, nausea and vomiting, and constipation. The use of opioids also carries the risk of addiction.
Make sure to talk with your doctor about all the side effects of opioid use.
Corticosteroids are given via injection or in a pill form that works to decrease swelling, reduce inflammation, and manage pain.
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.
For moderate to severe cases, oral corticosteroids may be best. When taken orally, corticosteroids can affect the whole body and help to clear existing HS lesions and prevent new ones from forming.
You may need a short-term course of steroids to manage flare-ups and longer-term oral corticosteroids in severe HS cases unresponsive 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 shifts. In addition, long-term use may lead to thinning skin, high blood sugar, and osteoporosis.
Androgens are hormones that may influence HS. In addition, 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)
You may take hormones for HS orally as the only therapy (monotherapy) for mild to moderate HS or used in combination with other treatments when severe.
Your doctor might avoid prescribing oral contraceptives that only contain progestin because there’s anecdotal evidence that HS may worsen when using this medication.
Side effects of hormone therapy in women can include blood clots if taken during pregnancy. In addition, men may experience decreased libido and problems ejaculating.
Retinoids are medications derived from vitamin A. They work by slowing down the growth of skin cells and can reduce inflammation. Retinoids can help treat a variety of inflammatory skin conditions, including acne and psoriasis.
Oral retinoids may be helpful for some individuals with HS. If you take 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 but can treat severe acne and HS lesions.
Oral retinoids should not be taken during pregnancy, as they may lead to congenital disabilities. 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, biological drugs may be an option. Biologics help your body build up a response against HS by targeting the parts of your immune system that stimulate inflammation.
Biologics given via injection or an intravenous (IV) infusion are usually taken weekly and can be administered at home (injections) or in a hospital or clinic by a medical professional (intravenous).
The only HS treatment approved by the Food and Drug Administration (FDA), and the one with the strongest evidence for use, is adalimumab (Humira). It’s FDA approved to treat moderate to severe HS.
Other biologics, such as infliximab (Remicade) and anakinra (Kineret), may also treat HS, but more research needs to be done in this area.
Side effects of biologics can include:
- pain near the injection site
- back pain
If you experience infections, your doctor may stop using biologics and explore other treatment options.
Rare but severe side effects can include autoimmune nerve symptoms and heart failure. Biologics can also cause an increased risk of lymphoma and infection. Speak with your doctor about the benefits and risks of this treatment.
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 has not 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 used include:
- Incision and drainage. The surgeon drains one or two lesions and then removes them to provide short-term relief for abscessed lesions.
- Deroofing. The surgeon removes the tissue above tunnels or abscesses, allowing the exposed area to heal, primarily for recurring lesions or tunnels.
- Wide excision. The surgeon removes the lesion and some surrounding healthy skin by using a scalpel, laser, or electrosurgical tool for extensive, recurring lesions.
If you think you might be a good candidate for surgery, talk with 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. Also, surgery only treats a specific area so that lesions may appear at new locations.
Wound care following surgery for HS is critical. Your doctor will choose an appropriate dressing based on the location and extent of the surgery. They may also recommend using an antiseptic wash during healing.
When caring for a wound after surgery for HS, it’s crucial to follow general best practices for wound care, including:
- 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
- watching carefully for signs of a potential infection
There are several energy sources that may help treat both mild and more severe forms of HS.
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 over 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. With the light source turned on, the drug reacts with the cells, causing them to die.
Radiation treatment has also been used to treat HS in some individuals. It’s a better treatment option for those who are not optimal candidates for surgery, but your doctor will weigh the side effects with its benefits.
You may feel some discomfort during some of these procedures. Other potential side effects that you may experience afterward can include temporary pain, redness, or swelling in the treated area.
Chronic radiation treatment can cause severe side effects like hair loss and the development of cancers, so make sure to talk with your doctor about all your treatment options, as well as the length of treatment.
A few natural treatments and lifestyle modifications may help with your HS.
Hidradenitis suppurativa skin care routine
Even with medication and physician-driven treatment plans, HS may be challenging to manage. Talk with your doctor about implementing a skin care routine, such as the following:
- Keep your skin cool. You will want to avoid overheating since it can exacerbate the symptoms.
- Use an antiseptic cleanser. An antiseptic or antimicrobial wash may help limit flare-ups.
- Try over-the-counter acne treatments. You can buy benzoyl peroxide face washes at your local grocery and drug store that may help.
- Avoid ointments and thick creams. You want to avoid plugging your hair follicles since it can aggravate HS over time.
- Shave or wax the hair around affected areas.
- Try to prevent excessive sweating. Excessive perspiration can trigger flare-ups. Try methods such as limiting tight clothes and synthetic fabrics, and limiting things that may increase sweating like spicy foods and alcohol.
Additionally, some activities 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
- using products that may contain irritants, such as detergents or perfumes
There’s also some indication that dietary supplementation may help people with mild to moderate HS, particularly zinc. Because of this, your doctor may recommend oral zinc supplements. Do not overdo it, though — too much zinc can cause an upset stomach.
Avoiding dairy or brewer’s yeast foods may help some people with HS. However, more research is needed to support this.
Make sure to talk with your doctor before starting any new skin care or dietary regime.
What is the best treatment for hidradenitis suppurativa?
In general, the earlier the treatment, the better the outcome. If prescribed early enough, the only FDA-approved treatment, Humira, has been shown to reverse the condition.
If Humira is not an option, topical clindamycin is the
What triggers hidradenitis suppurativa?
Triggers of hidradenitis suppurativa can include:
- weight gain
- hormone changes
- excessive heat
Does hidradenitis suppurativa go away?
There is no cure for this condition. However, you can successfully manage your symptoms with treatment and specific lifestyle changes.
How do you get rid of HS boils fast?
Boils, also known as furuncles, respond very quickly to antibiotics.
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 if you’re open to trying out any new therapies.
Your doctor or dermatologist may suggest surgical treatment for hidradenitis suppurativa if you have a lot of lumps and scars. Options include wide excision, tissue-sparing excision with electrosurgery, local excision, deroofing, cryoinsufflation, laser treatment, and incision and drainage. While dermatologists can do some of these procedures, others can be performed only by a surgeon.
Individuals with hidradenitis suppurativa
While living with hidradenitis suppurativa can have its challenges, there are a wide variety of treatment options available that can help provide symptom relief. Being proactive about treatment plans and working with your doctor are two key ways to increase your chances of successfully addressing your symptoms and managing your condition.