Being diagnosed with hidradenitis suppurativa (HS) can feel overwhelming, but there are good ways to manage it. Treatment usually involves a combination of medications, lifestyle changes, and sometimes surgery. It's important to start treatment early to help control symptoms and prevent further problems. The goal is to reduce pain, control flare-ups, and keep new breakouts from happening.
Treating HS isn’t a one-size-fits-all approach. Your doctor will likely recommend a mix of treatments depending on how severe your HS is. The first treatments you’ll try usually include medications, surgery (if needed), and lifestyle adjustments.
Medications for HS: The First Step in Managing Symptoms
Medications are often the first line of defense when treating HS. They can reduce inflammation, control infections, and stop new sores from forming. There are a few types of medications that your doctor might prescribe.
Antibiotics
Antibiotics are a common starting point, especially if your HS is mild. They help reduce inflammation and prevent infections in the skin.
Topical antibiotics. These are creams or lotions you apply directly to your skin. Clindamycin is an antibiotic that helps kill bacteria and calm inflammation in areas affected by HS. Resorcinol, another cream you put on your skin, helps break down hard, rough skin and can reduce pain and inflammation. Topical treatments generally have fewer side effects than oral medications. But you may have skin irritation, redness, or dryness.
Oral antibiotics. If your HS is more serious, your doctor may prescribe oral antibiotics, like doxycycline, minocycline, or tetracycline. These work by controlling inflammation in your body. You might need to take them for a long time to keep your symptoms under control. Oral antibiotics can cause nausea, an upset stomach, or sensitivity to sunlight. If you're taking them for a long time, talk to your doctor about the risks of antibiotic resistance.
Biologics
Biologics are newer drugs used to treat more serious cases of HS. They target specific parts of your immune system to calm down the inflammation that causes flare-ups. These drugs, like adalimumab (Humira) or secukinumab (Cosentyx), block certain proteins in your immune system that trigger inflammation. By doing this, they help control how severe your breakouts are and how often they happen.
Biologics are usually given as shots. You might start seeing improvement in your symptoms within a few weeks or months. Biologics can put you at risk of infections. Let your doctor know if you notice any signs of illness while taking these medications.
Hormonal treatments
For some women, hormones play a big role in HS flare-ups. In these cases, hormonal treatments like birth control pills, spironolactone, or medications that block androgens (male hormones) may help. Hormonal treatments help balance hormone levels, which can reduce inflammation and prevent breakouts. Hormonal treatments can sometimes cause headaches, weight gain, or changes in your period. Be sure to talk to your doctor about what to expect.
Other medications
Your doctor may use other drugs to treat your HS, including:
Steroid shots. Your doctor may prescribe steroids such as triamcinolone acetonide (Kenalog-10), to quickly calm severe flare-ups. These aren’t usually used long-term because of their side effects, which can include mood swings, weight gain, and trouble sleeping.
Botox shots. Your doctor may also suggest Botox injections directly into affected areas of your skin to relieve pain, decrease swelling, and prevent the growth of bacteria, which can cause inflamed bumps. Botox only works for about three to four months, so you may need repeated shots.
Surgery for Hidradenitis Suppurativa: When Is It Necessary?
If medications and lifestyle changes don’t fully control your HS, your doctor may suggest surgery. Surgery can remove painful nodules and help prevent new ones from forming.
Incision and drainage
This is a quick procedure where your doctor makes a small cut to drain pus from painful nodules. It helps relieve pressure and pain, but it doesn’t stop new nodules from coming back. Your doctors might try this option when your flare-ups are especially painful or if you have an infection that needs to be drained.
Deroofing
Deroofing is a procedure where your doctor removes the top layer of skin and tissue over tunnels (sinus tracts) that form under your skin. This helps the area heal from the inside out. Deroofing is often used when the HS has formed tunnels under the skin that don’t heal on their own.
Excision
Excision is a more involved surgery where your doctor removes the entire affected area, including all the nodules and sinus tracts. Sometimes, the surgeon will use skin grafts to cover the area afterward. Excision is for more severe cases of HS, where other treatments haven’t worked. It can take a few weeks to recover, and you’ll need to take care of the wound to prevent infection.
Laser surgery
Laser treatments are another option for removing HS nodules. Different types of lasers, including carbon dioxide lasers, can target affected areas without the need for large cuts. Laser treatments are less invasive and might result in fewer side effects. But they’re not an option for everyone and might require more than one session.
Lifestyle Changes: What Can You Do to Help Manage HS?
Medications and surgery are important, but you can also make some lifestyle changes to help manage your HS. These can reduce flare-ups and improve your skin’s overall health.
Skin care
Keeping your skin clean is a key part of managing your HS. Wash your affected areas every day with a gentle antimicrobial cleanser. Don’t scrub your skin with washcloths or loofahs so you don’t irritate it. Pat it dry instead.
Weight management
If you're carrying extra weight, losing some can help make your HS less severe. Excess weight can cause friction and sweating, which can make your symptoms worse.
Dietary changes
While there’s no specific HS diet, many people find that cutting back on sugar, dairy, and red meat helps. Keep track of your diet to see if certain foods trigger your symptoms.
Quit smoking
Smoking is a known trigger for HS. Quitting smoking can help reduce flare-ups and improve your skin’s health. Talk to your doctor about options to help you quit if you’re finding it hard.
Stress management
Stress is another thing that can make your HS worse. Managing stress through relaxation techniques like yoga, meditation, or therapy might help cut down on your flare-ups.
Clothing choices
Wearing loose-fitting, breathable clothing can help prevent fabrics from creating friction and irritating affected areas. Moisture-wicking fabrics can also help reduce chafing and sweating, which are known triggers for HS. Look for clothing made with synthetic materials or merino wool.
How Treatments Work Together to Manage HS
The best way to manage HS is often a combination of treatments. Medications help control inflammation and infection, surgery can take care of more serious nodules, and lifestyle changes help prevent new breakouts. Working together, these treatments can make a big difference in how often you have flare-ups and how severe they are.
For example, you might start with antibiotics and skin care tips. If your HS doesn’t improve, your doctor might suggest biologics or even surgery. Over time, you and your doctor can figure out a treatment plan that includes the best combination to keep your HS under control.
What to Expect as You Start Your Treatment Plan
Treating HS is an ongoing process. You’ll need regular checkups with your doctors to adjust your plan as needed. Here’s what you can expect:
Long-term care. HS is a chronic condition, so you'll likely need to keep up with treatments even when your skin is clear. Your doctor will help you create a plan that includes regular medication, skin care, and possibly surgical options if needed.
Ongoing skin care. It's important to stick to a good skin care routine, even when your symptoms are mild. This can include using medicated creams, gentle cleansers, and avoiding anything that irritates your skin.
Your HS Medical Team: Partners in Your Care
Managing HS often requires a team approach. Your medical team may include:
Dermatologist. A skin specialist who will likely lead your HS treatment
Primary care doctor. For overall health management
Surgeon. If surgical procedures are needed
Pain specialist. To help manage chronic pain
Mental health professional. To address the emotional impact of living with HS
Nutritionist. To help with dietary changes and weight management
These professionals will work together to create a comprehensive plan tailored to your needs.
Looking Ahead: Living Well With HS
Remember, every case of HS is different, and it might take time to find the right mix of treatments that work for you. With the help of your medical team, you can find relief from your symptoms and get back to feeling like yourself again.
By combining medications, surgery (when needed), and simple lifestyle changes, you can manage HS and live a more comfortable life. Talk to your doctor about your options, and keep in mind that treatment is an ongoing process – but with the right plan, you can keep your HS under control.
Show Sources
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SOURCES:
American Academy of Dermatology Association: “Hidradenitis Suppurativa: Diagnosis and Treatment.”
Canadian Hidradenitis Suppurativa Foundation. “Laser Therapy for Hidradenitis Suppurativa: A Promising Treatment Option,” “Practical Lifestyle Tips for Living and Thriving with Hidradenitis Suppurativa,” “The Role of Self-Care in Managing Hidradenitis Suppurativa.”
Cleveland Clinic: “Tetracyclines,” “Birth Control Pills,” “Triamcinolone injection.”
Johns Hopkins Arthritis Center: “Side Effects of Biologic Medications.”
Mayo Clinic: “Resorcinol (topical route),” “Hidradenitis suppurativa.”
National Library of Medicine: “A concise clinician’s guide to therapy for hidradenitis suppurativa,” “Surgical Treatment in Hidradenitis Suppurativa.”
UMass Chan Medical School: “Hidradenitis Suppurativa Center.”
