If you live with hidradenitis suppurativa (HS), you know how painful and frustrating it can be. HS causes swollen, painful bumps (often called boils) under the skin. These can break open into lesions, leak pus, and cause abscesses (painful, pus-filled lumps caused by inflammation) and scarring. Affected areas are places like the armpits, groin, and under the breasts.

Doctors still don’t know exactly why HS happens, but it involves inflammation and an overactive immune response in hair follicles.

Doctors often prescribe the antibiotic doxycycline for HS. But does it actually help? Let’s break it down.

When Is Doxycycline Prescribed for HS?

Doxycycline is an oral antibiotic. This means it’s a medicine you swallow as a pill or capsule. Doctors often prescribe it for HS when the condition is moderate or severe, especially if the bumps are inflamed, painful, or infected. Doxycycline is usually used when:

• You have moderate HS (meaning more than a few bumps and some tunnels under the skin, also known as sinus tracts or fistulas).
• You have flare-ups that cause pain, swelling, or pus.
• You need long-term treatment to keep HS under control.

Oral antibiotics like doxycycline are often a first-line therapy (meaning one of the first medicines doctors try) for this condition.

Doctors may prefer starting with doxycycline because it can treat both infections and inflammation.

How Do Oral Antibiotics Like Doxycycline Help HS?

Although antibiotics are best known for killing bacteria, doxycycline does more than that when it comes to HS.

Fighting Bacteria

Researchers have found that the bumps in hidradenitis suppurativa can be linked to certain types of bacteria, including Prevotella and Porphyromonas. Doxycycline can help reduce these bacteria and prevent infection in the skin.

Reducing Inflammation

Doxycycline doesn’t just fight germs — it also calms down the immune system. It lowers levels of certain chemicals in the body, like tumor necrosis factor (TNF) and interleukins, which cause swelling and pain.

This anti-inflammatory effect is one of the main reasons doctors use it for HS. In fact, even when no infection is found in the bumps, doxycycline can still help because of its immune-calming effects.

What Does the Research Say?

So, does doxycycline actually work for hidradenitis suppurativa? The answer seems to be yes for many people.

One large study from Denmark looked at 108 people with HS treated with tetracycline, doxycycline, or lymecycline (all from the same antibiotic family). After an average of a little over four months of treatment, people taking these medications saw:

• A drop in their HS score (a way doctors measure disease severity) from 26.1 to 17.9 points (a significant improvement)
• Less pain and distress from their disease
• Fewer boils — and more people had no new boils at all by the end of treatment

These improvements were statistically significant, meaning they likely weren’t due to chance.

Interestingly, the study found that people with lower body mass index (BMI) or more severe HS at the start appeared to have better results. This suggests doxycycline may be more effective for certain groups, though more research is needed.

How Long Does It Take for Doxycycline To Work for HS?

In studies, people with hidradenitis suppurativa usually took doxycycline for three to five months to see meaningful changes.

You may start to notice small improvements after a few weeks, but most people need to take it for several months before knowing if it works for them.

It’s important to know that HS is a chronic condition seen alongside other comorbidities (other chronic conditions) like obesity. Doxycycline may help control flare-ups, but it doesn’t cure HS. Often, it’s part of a bigger HS treatment plan plan that may include lifestyle changes (like quitting smoking or losing weight), skin care routines, and other medicines.

What Is the Best Antibiotic for HS?

There isn’t a single “best” antibiotic for everyone. But the tetracycline family (which includes doxycycline) is often a top choice because:

• It works against bacteria linked to HS.
• It has anti-inflammatory properties.
• It’s generally well tolerated by most people.

Other antibiotics doctors use for HS include:

• Clindamycin plus rifampin — A combination used for more severe cases
• Minocycline — Another tetracycline similar to doxycycline

Your doctor will decide which is best based on your HS stage, health history, and how you respond to treatment.

Can Doxycycline Reduce Inflammation?

Yes, and this may be its most important role in hidradenitis suppurativa.

Studies show doxycycline lowers inflammation by:

• Reducing inflammatory cytokines
• Helping the body produce anti-inflammatory chemicals

This makes doxycycline useful even when HS bumps aren’t clearly infected. Many dermatologists think this dual effect (antibacterial and anti-inflammatory) is why doxycycline works for so many people with HS.

What Are the Risks and Side Effects of Doxycycline?

Like all medicines, doxycycline can cause side effects. In the Danish study mentioned earlier, about 42 percent of people taking doxycycline had at least one side effect. The most common side effects were:

• Upset stomach (nausea, vomiting, diarrhea)
• Skin issues (rashes, itching, or sensitivity to sunlight)
• Headaches or flu-like symptoms

Less common but serious risks can include:

• Severe allergic reactions
• Esophageal irritation (especially if you don’t take it with enough water)
• Yeast infections

To reduce side effects, doctors usually recommend:

• Taking doxycycline with a full glass of water
• Not lying down right after taking it
• Using sunscreen

If side effects are too bothersome, your doctor may lower the dose or switch you to a different medicine.

Are There Practical Tips for Taking Doxycycline for HS?

If your doctor prescribes doxycycline for hidradenitis suppurativa, here are some practical tips to make the treatment safer and more effective:

1. Take It With Water and Stay Upright

Doxycycline can irritate your throat and stomach. Always take it with a full glass of water and stay upright for at least 30 minutes after taking it. This helps prevent burning or discomfort in your esophagus.

2. Protect Your Skin From the Sun

This medicine can make your skin more sensitive to sunlight, which means you could burn more easily. Wear sunscreen and protective clothing and try to avoid spending too much time in direct sunlight.

3. Watch for Stomach Upset

Some people feel nauseous or have diarrhea when taking doxycycline, but taking it with food can help. Consider having a light snack in addition to water when taking doxycycline.

4. Stick to Your Schedule

To get the best results, take doxycycline at the same times each day. If you miss a dose, take it as soon as you remember (unless it’s almost time for your next dose — in that case, skip the missed one).

These small steps can make a big difference in how well doxycycline works for you and how comfortable you feel while taking it.

Should You Try Doxycycline for HS?

If you have moderate to severe HS, doxycycline may be a good first option. It’s widely available, relatively affordable, and can help with both infection and inflammation.

But HS is complex, and doxycycline is not a cure. Some people may need stronger medications or even surgery for advanced disease.

Always talk to your dermatologist about what’s best for your stage of HS, and let them know if you experience side effects or if the medicine isn’t helping.

Talk With Others Who Understand

On MyHSTeam, people share their experiences with hidradenitis suppurativa, get advice, and find support from h others who understand..

Have you been prescribed doxycycline for your HS? Let others know in the comments below.