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You’re fed up with the painful bumps and constant swelling. Will another round of antibiotics make a difference this time? If you’re living with hidradenitis suppurativa (HS), you’ve probably asked yourself that before. Prescription antibiotics such as clindamycin or doxycycline are often used to treat moderate to severe HS, but how well do they actually work? Are they always the best option?
In this article, we’ll explain how antibiotics are used to treat HS, which ones are most common, and how long treatment might last. You’ll also learn about possible side effects and what other treatments might help if antibiotics aren’t enough.
Also known as acne inversa, hidradenitis suppurativa is a chronic inflammatory skin condition. HS causes painful, recurring bumps under the skin that can look like boils, lesions, lumps, or nodules. These bumps usually appear in areas with apocrine sweat glands — such as the armpits, groin, and under the breasts — where sweat is released into hair follicles.
There’s no cure for HS, but a range of treatment options can help manage the symptoms and improve quality of life. Antibiotics are one option.
To better understand the use of antibiotics in HS treatment, myHSteam spoke with Dr. Alexa Kimball, a professor of dermatology at Harvard Medical School and a leading researcher in HS. She shared advice for managing symptoms and explained how antibiotics may help.
Even though HS isn’t caused by an infection and isn’t contagious, antibiotics are often part of medical treatment for this condition. Antibiotics are known for fighting bacteria, but some also help reduce swelling and irritation in the skin. Doctors call this an anti-inflammatory effect — the medicine helps calm an overactive immune response.
In HS, the immune system reacts too strongly around hair follicles and sweat glands, leading to inflammation and painful nodules. Antibiotics may help by:
For mild to moderate HS, a topical antibiotic (applied directly on skin) may be used. For moderate to severe HS, your dermatologist may prescribe an oral antibiotic (taken by mouth). Oral antibiotics can also help treat or prevent flare-ups.
Dr. Kimball explained that as more treatment options for HS become available, she tends to rely less on antibiotics alone. “As I’ve gotten more sophisticated in my approach, I use them less and less,” Dr. Kimball said. When she does prescribe antibiotics, it’s typically for an HS flare. “They certainly have benefits, but for lots of people, they aren’t going to be enough,” she said.
Not all antibiotics work the same way. Some are used on their own, while others work better in combination. Your doctor may adjust the type or dose based on how your skin responds.
These are applied directly to affected areas, such as the armpits or groin. Topical antibiotics help reduce bacteria and inflammation. For mild HS, topical clindamycin may be prescribed to use daily for several weeks. If your HS is more severe or topical treatment isn’t enough, your doctor may add an oral antibiotic.
For moderate to severe HS, oral antibiotics may be needed, either alone or with a topical antibiotic. Common oral antibiotics to treat HS include:
Your dermatologist will recommend the antibiotic or combination that’s most likely to help your symptoms. Combination therapy, such as clindamycin plus rifampin, may be especially effective for moderate to severe hidradenitis suppurativa.
The length of treatment depends on how severe your symptoms are and how well your skin responds. For a short-term flare, a few weeks may be enough. For chronic HS or frequent flares, treatment may last up to three months. If antibiotics haven’t helped after about three months, your doctor may consider other treatments.
Dr. Kimball emphasized that finding the right treatment can take time: “In my clinical practice, it usually takes about a year to get [patients] to an optimized therapy, and that still takes some tweaks.”
Like all medications, antibiotics can cause side effects, which vary depending on the type and dosage. Common side effects include:
Antibiotic resistance is becoming more common in people with HS. This happens when bacteria change in ways that make these medicines less effective. In one study, more than 80 percent of HS lesions contained bacteria that no longer responded well to common antibiotics like penicillin and clindamycin.
One myHSteam member shared their experience: “I’ve been on so many antibiotics for HS that I’ve become resistant.” Another member expressed their frustration with antibiotic resistance. “My doctor says I’m really resistant to antibiotics,” they said. “Not sure what to do.”
To lower your risk of antibiotic resistance, carefully follow your doctor’s directions for how and how long to take these drugs.
In the United States, all antibiotics require a prescription from a licensed healthcare provider. Some topical antibiotics, like Neosporin, are sold over the counter (OTC). However, the ones typically used for HS — such as topical clindamycin — must be prescribed.
Antibiotics can help reduce inflammation and manage HS flare-ups, but they’re not the only treatment option. Dr. Kimball explained that having more choices allows doctors to tailor treatment based on each person’s needs: “The nice thing about having multiple approved therapies is that there are patients where different approaches are more appropriate and less appropriate, depending on comorbidities, preference, and other availability, as well.”
Biologic medicines may be used to target the immune system more directly. Currently, the U.S. Food and Drug Administration (FDA) has approved three biologics for treating HS:
Biologics are given as subcutaneous (under the skin) injections, which you can usually do at home.
Some myHSteam members have found relief with biologics. “I’ve tried all antibiotics, and nothing worked,” one member shared. “I’m currently taking a biologic, and it’s slowly taking effect. I wish they could find something that works straight away.”
“Just returned to treatment with a biologic and antibiotics,” another member said. “Flare-ups are getting under control.”
Doctors may prescribe oral retinoids, such as acitretin or isotretinoin. Hormone therapies, like finasteride, spironolactone, or oral contraceptives, may help if flares are linked to hormonal changes.
In more severe cases, certain procedures may be considered. These include:
“This is a great time for HS patients and for the clinicians who treat them,” Dr. Kimball said. “We now have proven therapies with strong records for both safety and efficacy that are really very straightforward to use — and that [help] patients feel well while they’re on them.”
On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.
Have you used antibiotics to treat your HS? How well did they work for you? Let others know in the comments below.
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I broke out again, this time 2 of the knots has a weird shape. Like a volcano and top is tough. I continue on my antibiotics and and my salve. Depressed, about the time I think… read more
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