It may be tempting to want to pop, squeeze, or pick at your painful hidradenitis suppurativa (HS) cysts (also known as acne inversa). However, popping even everyday pimples is discouraged by the American Academy of Dermatology Association. Doing so can damage or scar the skin, worsen HS flare-ups, and increase the risk of bacterial infection.

Some members of myHSteam find that following that urge to do it yourself makes things worse. “I squeezed a boil, and now all of a sudden, it got huge and hard,” wrote one member. Popping HS cysts can also be intensely painful if you do it at home without an anesthetic. “Popping is so painful, and I can only suffer so much before I can’t take it anymore,” said another.

In addition to these risks, it can be difficult to reach HS cysts in the armpits and groin areas.

Know when to get help from qualified health care professionals for your symptoms of HS. There are several treatments that can be performed by a certified dermatologist. In this article, we discuss those treatment options and safe at-home remedies that can help ease HS symptoms.

When To See a Dermatologist

Diagnosing and treating HS early in its development is the most effective way to manage the skin condition. It is important to see a dermatologist if you begin to experience any of the following symptoms with your HS lesions:

• Worsening pain
• Beginning to spread in multiple areas
• More frequent flare-ups
• Lesions returning soon after treatment
• Lesions interfering with daily activities or mobility
• Lesions becoming infected

Treatments for HS Cysts

There is no cure for HS, but many treatments are available to prevent new lesions from forming and to manage the symptoms (most commonly pain and suppuration) of current lesions. Your dermatologist can evaluate your HS cysts and determine the best way to treat them — either with medication, steroid injections, incision and drainage, or surgical procedures for more severe HS skin disease.

Medications

Your dermatologist may prescribe you one or more of the following medications:

• Antiseptic agents or acne treatments — Chlorhexidine, zinc pyrithione, and resorcinol cream
• Topical antibiotics — Clindamycin (Cleocin T, Clinda-Derm)
• Oral retinoids — Acitretin (Soriatane), isotretinoin (Absorica, Accutane, Zenatane, Myorisan), and alitretinoin (Panretin)
• Antibiotics — Clindamycin (Cleocin), doxycycline (Monodox), or rifampin (Rimactane) to fight inflammation, infections, and new breakouts
• Steroids — Corticosteroids and prednisone to reduce inflammation and improve symptoms
• Biologics — Tumor necrosis factor inhibitors adalimumab (Humira), infliximab (Remicade), and etanercept (Enbrel) to modulate the immune system
• Hormonal medication — Estrogen-containing combined oral contraceptives (birth control pills)
• Pain medication — Over-the-counter pain relievers, which include acetaminophen (Tylenol) and nonsteroidal anti-inflammatory medications such as ibuprofen (Advil), to help relieve discomfort

Procedures for HS Cysts

Your dermatologist may also perform the following procedures to treat HS cysts and other HS lesions. Note that these methods typically provide short-term pain relief.

• Steroid injections, such as triamcinolone (sold as Aristospan and Kenalog-10, among other brand names) are administered into the sores to reduce swelling and inflammation.
• Incision and drainage of a cyst is often the preferred treatment option. Your doctor will apply a numbing cream on the skin, then make an incision on the cyst, allowing the pus to drain out.

Many members on myHSteam have shared their experiences with these procedures done by a dermatologist. “When I have recurring boils, I usually go to my dermatologist to get them injected, and very rarely do they come back in the same spot,” wrote one member. “I had a really deep cyst in my buttock/perianal area. My dermatologist made an incision and drained the cyst, but it’s taking months to heal,” said another member.

Surgical procedures might be necessary for severe HS or long-term treatment. These include:

• Punch debridement, also called limited unroofing, involves surgically removing an inflamed lesion.
• Surgical removal of the affected area of skin is another type of treatment. However, a skin graft might be required to close the wound.

“I had my HS cysts removed by surgical methods. If they are professionally removed by surgery, they do not return to the same place,” shared a member. “I had a huge cyst above my tailbone that was extremely painful. I had it surgically removed, and it healed great,” said another member.

Treatment plans may change over time depending on the severity and frequency of HS symptoms. It is important to continue seeing your dermatologist to keep your HS well-managed in the long term, even if HS symptoms improve.

When To Manage HS Cysts at Home

You might be able to treat mild HS at home. Following a daily skin care routine can be very beneficial for treating HS abscesses. To help alleviate or prevent flare-ups, you might try to:

• Avoid popping, squeezing, and picking at HS lesions.
• Avoid using washcloths, loofahs, or brushes directly on HS lesions.
• Avoid shaving or using depilatory creams.
• Wash your skin with gentle soaps or cleansers daily and dry skin thoroughly.
• Use over-the-counter antibiotic salves to soothe or aid in the healing of your skin.
• Blot your skin with a noncomedogenic powder to reduce discomfort.
• Apply a warm compress for 10 minutes to reduce pain.

Some members report that topical products such as turmeric, honey, tea tree or neem oil, aloe vera, and/or apple cider vinegar seem to help reduce inflammation, fight bacteria, and heal lesions. Ask your doctor about taking nutritional supplements such as zinc or vitamin B12.

Not everyone responds to treatments and at-home remedies in the same way. Each comes with risks and benefits. Speak to your doctor about the best remedies for you and how to care for your wounds at home.

Talk With Others Who Understand

Living with HS can be difficult, but you are not alone. On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 24,000 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Have you popped your HS cysts yourself? Did it help or make things worse? Share your experiences in the comments below or by posting on myHSteam