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Treatments for Hidradenitis Suppurativa (HS)

Medically reviewed by Angelica Balingit, M.D.
Written by Kelly Crumrin
Updated on May 29, 2024

If you’re living with hidradenitis suppurativa (HS), you may have several effective treatment options to manage this sometimes challenging skin condition. HS treatment options fall into two main categories: medications and surgical procedures.

The best treatment option for you will depend on several factors, including the severity of your HS symptoms and your general health and medical history. Some cases of HS prove difficult to treat. Ask your health care provider or dermatologist to create a plan specific to your needs. Make an appointment with a specialist, if necessary.

Antibiotics

Antibiotics fight infections by killing bacteria and may also reduce inflammation. Although HS is not caused by an infection, lesions may become infected in severe stages of HS. Antibiotics may be prescribed to treat infected lesions, heal lesions, and prevent new lesions. Antibiotics to treat HS can be applied topically to the affected areas or taken orally (by mouth). In very severe cases, IV antibiotics may be used to control HS symptoms.

Topical antibiotics like clindamycin work only where applied, whereas oral antibiotics like doxycycline and minocycline work throughout the body. Topical antibiotics are usually prescribed for mild HS, whereas oral antibiotics are more likely to be prescribed for moderate to severe hidradenitis suppurativa.

There are several types of antibiotics your doctor might prescribe to treat HS. A doctor may perform a culture swab of the suspected infected lesion to determine which antibiotic should be used.

Side effects will vary for each medication and often increase with higher dosages. Common side effects of antibiotics generally include:

  • Headache
  • Dizziness
  • Fatigue
  • Skin sensitivity to sunlight
  • Nausea or diarrhea

The use of antibacterial soaps also has been shown to help reduce the symptoms of HS.

Hormonal Birth Control

The exact cause of HS is unknown, but many scientists believe sex hormones may play a role in triggering the condition. As a result, hormonal contraceptives such as the birth control pill are sometimes prescribed to people with HS to control their hormones. Some health care providers recommend taking hormonal therapies and antibiotics at the same time.

Birth control pills can reduce the amount of fluid coming from lesions and also be helpful if HS flares occur during periods. Oral contraceptives sometimes come with mild side effects, such as weight gain, bloating, and bleeding between periods — especially for the first few weeks or months of taking them.

Metformin is another medication used to treat mild to moderate HS. This drug is primarily used to treat diabetes but has shown promise in treating HS, too. Researchers aren’t sure just how metformin works in HS, but its action may be due to a combination of effects, such as reducing insulin resistance, changing immune cells, and easing inflammation. Its efficacy as an HS treatment has not yet been evaluated in clinical trials.

Similarly, spironolactone (Aldactone) may be prescribed for cases of HS in which hormonal imbalance with excess testosterone is thought to play a role in triggering symptoms. Both spironolactone and hormonal birth control are believed to work by keeping hormone levels balanced.

Corticosteroids

Corticosteroids like prednisone and prednisolone work to reduce inflammation and are sometimes used to treat HS flare-ups in the short term. Corticosteroids (also called steroids) can help heal existing lesions and prevent new ones from forming. Treatment with systemic corticosteroids is usually limited to short periods during major flares because of side effects and the dangers of long-term use.

Common side effects of corticosteroids include:

  • High blood glucose (sugar)
  • Fluid retention
  • Trouble sleeping or insomnia
  • Rounding of the face (“moon face”)
  • Mood swings and emotional changes (euphoria, depression, anxiety, or mania)

Side effects can become more severe at higher dosages and with longer-term use.

Injecting steroids directly into the lesions helps reduce the inflammation, but this should be avoided if there are clear signs of infection.

Biologics

Biologic medications are mostly used to treat severe cases of HS. Biologic medications are genetically engineered antibodies, or proteins that identify and neutralize aspects of the immune system that cause inflammation. Adalimumab (Humira) and secukinumab (Cosentyx) are biologics approved by the U.S. Food and Drug Administration (FDA) to treat HS. Infliximab (Remicade) and ustekinumab (Stelara) are not FDA-approved for HS, but they’re sometimes prescribed off-label to treat cases of HS that haven’t responded to other treatments. More biologics are being studied in clinical trials for the treatment of hidradenitis suppurativa.

Biologics are given by injection or IV infusion. Every biologic medication has its own set of side effects, but rash or irritation at the injection site is common for most biologic medications. These medications also increase a person’s risk of tuberculosis infections.

Biosimilars are drugs that are highly similar to, but not exact copies of, original brand-name biologic medicines. They are tested rigorously to make sure they have no meaningful differences in safety and potency compared with the original biologic drug. Several biosimilars are available for adalimumab.

Retinoids

Oral retinoids aren’t a first-line therapy for HS, but they can be used for stubborn cases. Isotretinoin, which is most commonly used for severe nodulocystic acne, has proved helpful for some people with HS that resists other treatments. This medicine is usually taken for about six months. Some studies have shown that acitretin may offer similar benefits.

Ask your doctor about side effects before starting treatment. Isotretinoin can affect liver enzymes and blood lipid levels and can also cause severe birth defects if taken during pregnancy. Acitretin may cause back pain, ringing or buzzing in the ears, difficulty moving, increased sensitivity to pain and touch, and other unwanted effects.

Incision and Drainage

Incision and drainage, also called I&D or lancing, can relieve pressure and pain caused by abscesses, nodules, and sinus tracts. During this procedure, a doctor cuts and drains fluid from a lesion and then washes it with saline if needed.

Although I&D can provide fast pain relief, it generally does not offer long-term benefits for people with HS. It also won’t prevent new lesions from developing in the same location. The I&D recurrence rate is almost 100 percent. This means that if you undergo this procedure, your HS symptoms in the affected area are almost guaranteed to return.

Most experts don’t recommend I&D as an effective HS treatment strategy, and there’s limited evidence to support its use. If you need immediate pain relief, ask your health care provider or dermatologist about your options.

Punch Debridement

Punch debridement, also called mini-unroofing, is the removal of individual HS lesions. In a mini-unroofing procedure, a doctor uses a round tool often used for biopsies to “punch out” the lesion. Afterward, the wound will be cleaned and dressed.

Punch debridement is minimally invasive and can usually be done in a doctor’s office. Many people find that their lesions do not return afterward. Mini-roofing generally involves scarring and does carry some risk of infection.

Unroofing

Unroofing, also called deroofing, is a surgical procedure that may treat advanced HS. Unroofing is especially suited for people whose HS consistently recurs. Usually performed under a local anesthetic, the procedure involves a physician removing skin that covers tunnels that have formed under the skin. A local unroofing procedure treats one lesion, and an extensive unroofing treats multiple lesions across an area of the body.

Unroofing can be performed using a laser or more traditional surgical instruments. Laser unroofing is frequently used for more severe lesions and larger areas of tunneling. Unroofing can leave a person with significant scarring.

Excision

Excision is a procedure to remove lesions and surrounding tissue. Excision is generally recommended only for people with severe HS that can’t be managed with other medical treatments. Excision can be done in a traditional surgical setting or with a laser. Surgical excision requires general anesthesia and may require a hospital stay and lengthy healing time. Laser excisions can be performed using a local anesthetic.

A skin graft or another advanced wound management may be needed after removing the affected skin. Excision can lead to significant scarring.

Laser and Light Therapy

Treatment with laser or light therapy is an option for people with moderate to severe HS that hasn’t responded to other treatments. One type involves the same kind of laser (called a neodymium-doped yttrium aluminum garnet or Nd:YAG laser) that destroys hair follicles in laser hair removal. The use of Nd:YAG laser treatments is based on the belief that HS originates in the hair follicle. Nd:YAG laser treatments are often given monthly over several months.

HS can also be treated with intense pulsed light, a method that’s also used to remove hair and treat acne. Intense pulsed light is believed to reduce HS symptoms by lowering inflammation, killing bacteria, and destroying hair follicles.

Side Effects of HS Treatments

Any medication or procedure can cause side effects. Each HS treatment brings specific potential side effects, some of which are very common and others that are rare. Whether you’ll experience none, some, or all of the potential side effects may depend on whether you have other health conditions or are taking other medications, as well as on your age or ethnicity. Your doctor can help you assess the risks and benefits of each HS treatment in context of your family history and condition.

Lifestyle Changes

Some lifestyle changes can help reduce discomfort and manage the symptoms of hidradenitis suppurativa, including healthy eating, avoiding cigarettes, and soothing skin care.

Quit Smoking

Quitting smoking is an important step for overall well-being. Although more research is required to fully understand the impact of smoking on HS, some studies have found a relationship between smoking and more severe HS symptoms. There’s some evidence that quitting may help with symptoms. A study of people with HS found that those who smoked were less likely to achieve remission (periods of reduced or no symptoms) than those who didn’t smoke or had previously quit.

Eat a Balanced Diet

Eating a balanced diet can help people with HS feel their best, lose weight, or maintain a healthy weight — which can help manage symptoms. Popular diets, such as the paleo and ketogenic diets, have been touted as options for achieving remission. These eating plans may be helpful for individual people, but there’s no definitive scientific evidence to support them.

Although no diet has been shown to cure HS, there’s some evidence that eliminating dairy and brewer’s yeast (found in bread and beer) and reducing sugar may ease symptoms of HS.

Ask Your Doctor About the Role of Supplements

Some people seek to treat their HS with dietary supplements. Always consult your doctor before making significant changes to your diet or adding supplements to your routine. It’s important to maintain the traditional drug regimen established by your doctor. These treatments were shown to be effective in rigorous, scientific trials.

It’s also vital to check with your doctor before beginning a natural or complementary regimen so that they can warn you about any potential interactions and correctly interpret any side effects.

Zinc

Zinc is an essential mineral found in foods and available in supplements. There’s limited evidence that zinc used topically — not as a dietary supplement — might be helpful for people with mild to moderate HS. Topical zinc has shown to have antibacterial properties that may last longer than other topical antibacterials, such as chlorhexidine gluconate. More research must be done to determine if zinc is a helpful treatment for HS.

Vitamin D

More research is also needed to understand vitamin D’s effectiveness as an HS treatment. Researchers have reported that many people with HS have vitamin D deficiencies. Some findings show that people with HS noted symptom improvement when taking vitamin D supplements. Your doctor may check your vitamin D levels when you’re diagnosed and recommend supplements. Be sure to talk to your doctor about the right dosage — too much vitamin D supplementation can be harmful.

Turmeric

Turmeric has proven anti-inflammatory properties and is a popular natural remedy for several autoimmune and inflammatory conditions. Several clinical studies have found that turmeric can benefit people with various health conditions, including arthritis and metabolic syndrome. However, at present, there isn’t scientific evidence to support the use of turmeric for HS. Turmeric is generally safe to use in the amounts called for in cooking, but there’s some evidence that large doses can cause nausea and diarrhea.

Care for Your Skin

Protecting your skin from irritants can help minimize discomfort and reduce the chances of making symptoms worse. Strategies to take care of your skin include wearing loose-fitting clothing, avoiding shaving irritated areas, and using gentle, nonabrasive soaps in the shower.

Is There a Cure for HS?

There is no cure for hidradenitis suppurativa, but early diagnosis and treatment can help manage the condition and minimize progression. HS treatments focus on keeping new lesions from developing, preventing tunneling under the skin, removing lesions and tunneling, and managing pain.

People’s experiences with HS vary greatly. Some people have long-term remission following treatment with prescription medications or surgery or by making significant lifestyle changes, such as losing weight and stopping the use of cigarettes. However, no particular treatment or set of treatments works for everyone, and recurrence rates vary based on the location of lesions and age. Your doctor can help you figure out the treatment plan that works best for your HS.

Talk With Others Who Understand

On myHSteam, the social network for people living with hidradenitis suppurativa and their loved ones, more than 41,000 members come together to ask questions, give advice, and share their stories with others who understand.

Do you have early-stage or severe hidradenitis suppurativa? What treatments have you tried? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Treating Hidradenitis Suppurativa With Antibiotics and Hormones — Mayo Clinic
  2. Metformin Has Anti-Inflammatory Effects and Induces Immunometabolic Reprogramming via Multiple Mechanisms in Hidradenitis Suppurativa — British Journal of Dermatology
  3. Metformin Treatment of Hidradenitis Suppurativa: Effect on Metabolic Parameters, Inflammation, Cardiovascular Risk Biomarkers, and Immune Mediators — International Journal of Molecular Sciences
  4. Hidradenitis Suppurativa: Diagnosis and Treatment — American Academy of Dermatology
  5. Secukinumab Gains FDA Approval To Treat Hidradenitis Suppurativa — AJMC
  6. Hidradenitis Suppurativa and Biologics: Get the Facts — Mayo Clinic
  7. What Are Biosimilar Drugs? — American Cancer Society
  8. Is There a Biosimilar for Humira? Yes, Here Are 10 Humira Biosimilars To Choose From — GoodRx Health
  9. Isotretinoin: Overview — American Academy of Dermatology
  10. Drug Survival of Oral Retinoids in Hidradenitis Suppurativa: A Real-Life Cohort Study — American Journal of Clinical Dermatology
  11. Acitretin (Oral Route) — Mayo Clinic
  12. Surgery for Hidradenitis Suppurativa — Mayo Clinic
  13. Surgical Treatment in Hidradenitis Suppurativa — Journal of Clinical Medicine
  14. Evidence-Based Approach to the Treatment of Hidradenitis Suppurativa/Acne Inversa, Based on the European Guidelines for Hidradenitis Suppurativa — Reviews in Endocrine and Metabolic Disorders
  15. Objective Scoring of Hidradenitis Suppurativa Reflecting the Role of Tobacco Smoking and Obesity — British Journal of Dermatology
  16. Impact of Smoking Status on Remission in Hidradenitis Suppurativa — American College of Rheumatology
  17. Hidradenitis Suppurativa and Diet: What’s Recommended? — Mayo Clinic
  18. North American Clinical Management Guidelines for Hidradenitis Suppurativa: A Publication From the United States and Canadian Hidradenitis Suppurativa Foundations — Journal of the American Academy of Dermatology
  19. Hidradenitis Suppurativa and Five Key Vitamins and Minerals — Skin Appendage Disorders
  20. Curcumin: A Review of Its’ Effects on Human Health — Foods
  21. Hidradenitis Suppurativa — Mayo Clinic
  22. Managing Hidradenitis Suppurativa: Early Treatment Is Crucial — Mayo Clinic
  23. Hidradenitis Suppurativa — Cleveland Clinic

Updated on May 29, 2024
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Angelica Balingit, M.D. is a specialist in internal medicine, board certified since 1996. Learn more about her here.
Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here.

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