Hidradenitis suppurativa (HS or acne inversa) is a chronic inflammatory skin condition characterized by painful, recurring bumps that develop underneath the skin. HS bumps (also referred to as boils, lesions, lumps, or nodules) occur in areas of the body that contain apocrine sweat glands — the glands that release sweat into hair follicles.

Currently, there is no cure for HS. However, a range of treatment options can help manage the symptoms of HS and their impact on quality of life. Antibiotics are one option for the treatment of HS.

To better understand the use of antibiotics in HS treatment, myHSteam recently spoke to Dr. Alexa Kimball, a professor of dermatology at Harvard Medical School. Dr. Kimball is also president of Physician Performance LLC and CEO of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. Dr. Kimball offered guidance to people with HS on how to manage their symptoms and discussed the effectiveness of antibiotics in treating HS.

How Antibiotics Can Help Treat Hidradenitis Suppurativa

While hidradenitis suppurativa is not caused by infection, the use of antibiotics is common in its treatment. In addition to their antibacterial activity, many antibiotics commonly prescribed for HS are known to have anti-inflammatory effects. This means they act on the immune system to reduce inflammation. Antibiotics may be effective in helping to decrease bacteria living on the skin’s surface, treat infected lesions, heal them, and prevent new ones from forming.

Dermatologists often prescribe antibiotics for lesions that may be infected, but also to reduce the number and types of bacteria on the skin that can result in inflammation. Usually, topical antibiotics are prescribed for mild cases of HS, while oral antibiotics are prescribed for moderate to severe HS.

The perceived effectiveness of antibiotics in treating HS may be disguised by the natural duration of its symptoms: A study of 110 people with HS revealed the average duration of painful nodules to be 6.9 days, which is about as long as an average course of antibiotics.

“As I've gotten more sophisticated in my approach, I use them less and less,” Dr. Kimball noted. When she does prescribe antibiotics, it is typically for an HS flare. “They certainly have benefits, but for lots of people, they are not going to be enough.”

Dr. Kimball explained that she leans towards hormonal treatments, like oral contraceptives or Aldactone (Spironolactone), rather than antibiotics for medium- and long-term treatment.

Antibiotics Used to Treat Hidradenitis Suppurativa

Antibiotics for HS may be applied topically or administered orally. Topical antibiotics work locally (only on affected areas, where they are applied), while oral antibiotics work systemically (throughout the body). Some of the most commonly prescribed oral antibiotics for HS include:

• Tetracyclines (first class to be prescribed)
• Clindamycin
• Rifampin
• Dapsone
• Moxifloxacin
• Metronidazole
• Erythromycin
• Doxycycline

Topical Clindamycin is usually prescribed for mild HS.

Side Effects From Hidradenitis Suppurativa Antibiotics

The side effects of antibiotics for HS vary according to the type of medication and can increase with higher dosages. Generally, the most common side effects are:

• Headache
• Dizziness
• Fatigue
• Skin sensitivity to sunlight
• Nausea
• Diarrhea
• Stomach upset
• Abdominal pain
• Skin symptoms including redness, drying, itchiness, burning, peeling, and oiliness

Members of myHSteam on Hidradenitis Suppurativa Antibiotics

Many myHSteam members have shared their experiences with taking antibiotics:

• “I have tried all antibiotics, and nothing worked. I am currently taking Humira, and it’s slowly taking effect. I wish they could find something that works straight away.”
• “Just returned to treatment with Humira and antibiotics. Flare-ups are getting under control.”
• “I’ve been on so many antibiotics for HS that I have become resistant.”
• “My doctor says I’m really resistant to antibiotics. Not sure what to do.”
• “I have had HS for over 40 years. Antibiotics are only good for infection, and most HS lesions are not infected.”

You Are Not Alone With HS

At least 1 percent of people in the world have HS. When you join myHSteam, you join a community of more than 15,000 members who can relate to your experience. The myHSteam members can provide you with support through even the most challenging days.

Have you used antibiotics to treat your HS? Share your experience in the comments below or on myHSteam.com.