Although hidradenitis suppurativa (HS) is not curable, creating the right treatment plan can help manage symptoms, prevent flare-ups, and reduce complications like tunneling or scarring. Early intervention is especially important to avoid these issues. Your health care provider plays a key role in diagnosing HS and creating a treatment plan tailored to your needs. Open communication is essential — don’t hesitate to ask questions about why a specific treatment is being recommended or to voice concerns if something doesn’t feel right for you.

If side effects or challenges from a treatment are affecting your quality of life, speak with your doctor about other options that might work better. Advocating for your care is a key step in finding relief and managing HS effectively.

Medications to Treat HS Symptoms

From topical treatments to biologics, learning about the different treatments can help you and your doctor pick the best way to manage HS.

Topical Treatments

For mild HS, topical antibiotics like clindamycin are often the first option. These can reduce inflammation and treat abscesses. Resorcinol cream, which helps unclog hair follicles, may also reduce pain and swelling.

Oral Medications

Oral antibiotics, such as doxycycline or clindamycin, may be prescribed for more severe cases. For women, hormonal therapies like birth control pills or spironolactone might help manage symptoms. Retinoids, commonly used for acne, are another option and can be taken orally or applied topically.

Biologics

Three biologic medicines — bimekizumab-bkzx, adalimumab, and secukinumab — are FDA-approved specifically for treating moderate to severe HS.

Biologics target specific parts of the immune system to reduce inflammation. Since HS is an autoinflammatory disease (where the immune system overreacts and attacks the body’s own cells), biologics help calm this immune response. They also address systemic (body-wide) effects of HS, preventing damage beyond the skin.

These medications have been used successfully for years to treat other conditions, like inflammatory bowel disease and spondyloarthritis, which are sometimes linked to HS. Biologics can be administered through injections under the skin or via IV in a clinic.

Doctors may also combine biologics with other treatments, such as surgery or additional medications, to improve outcomes and reduce symptoms. If you’re not seeing results from your current treatment, ask your doctor if biologics could be right for you.

Pain Management

Over-the-counter pain relievers can help manage discomfort, but for severe pain, your doctor might recommend stronger medications. Non-medication options like stretching, meditation, or breathing exercises can also reduce stress and ease tension, which may help with pain.

Surgical and In-Office Options for HS

Different treatments might help, depending on the seriousness of your condition. Talk to your health care provider to figure out which option is best for you.

Surgical Options

• Incision and Drainage (I&D): Drains abscesses temporarily but doesn’t prevent recurrence.
• Deroofing: Removes the top layer of skin to treat tunnels under the surface, with less chance of recurrence than I&D.
• Local Excision: Removes small areas of affected tissue; works best for early HS.
• Wide Excision: Treats larger areas of diseased skin and tissue in more advanced cases.
• Laser Therapy: Removes diseased skin using lasers for longer-lasting relief.
• Cryoinsufflation: Uses liquid nitrogen to treat tunnels under the skin.

After surgery, wounds may heal naturally, be stitched closed, or require skin grafts for reconstruction.

In-Office Options

• Corticosteroid Injections: Reduce swelling and stop early lumps from worsening.
• Laser Hair Removal: Targets hair follicles in problem areas to reduce new lump formation.

Self-Management and Lifestyle Changes

By incorporating self-management strategies and making certain lifestyle changes, people with HS can better cope with the condition and reduce its impact on daily life

• Daily Skincare: Maintaining a gentle skincare routine is key if you’re living with HS. Use non-soap cleansers and avoid any harsh scrubbing on your skin. Antiseptic washes like benzoyl peroxide (five percent to 10 percent) can be used to reduce bacteria, but make sure you introduce them gradually to prevent irritation.
• Diluted Bleach Baths: For some patients with chronic bacterial infections, diluted bleach baths may help. However, they’re not suitable for everyone. Talk to your doctor to see if this option is safe for you.
• Pain Management: Managing pain in HS is a critical component of treatment. Cold compresses can reduce swelling. Acetaminophen and ibuprofen can provide some relief from pain. For persistent, chronic pain, specialized medications prescribed by a pain specialist might be necessary.
• Weight Management and Nutrition: Maintaining a healthy weight and staying active is important to overall health and well-being. It is not yet clear whether weight loss improves HS or the effectiveness of treatments used in HS. The role of nutrition in HS is also not yet clear. If you think certain foods may trigger your HS symptoms, consider keeping a food journal or using an app like Hidradenitis Suppurativa Papaya or PatientSpot to track your diet and identify potential patterns. This can help you make informed choices about what works best for your body.
• Stop Smoking: Quitting smoking is important for overall heart health and cardiovascular well- being. Researchers are continuing to study whether smoking cessation directly improves HS or the effectiveness of treatments. What people often aren’t told is that the stress of quitting and withdrawal symptoms can temporarily worsen HS before it gets better. If you’re considering quitting, be patient with yourself and work with a health care provider to manage potential challenges along the way.

Your Interactive Patient Guide to Hidradenitis Suppurativa

Learning about hidradenitis suppurativa (HS) doesn’t have to be confusing or take hours of research. Use our free guide to make understanding your condition simpler, more efficient, and custom to your needs. Learn more.

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​​Make HStory. Importance of Seeking a Dermatologist. https://www.makehstory.com/dermatologist-importance.

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Čagalj AM, et al. New and Emerging Targeted Therapies for Hidradenitis Suppurativa. International Journal of Molecular Sciences. April 2022. https://doi.org/10.3390/ijms23073753.

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