Treatment - Corticosteroids

Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease that begins when clogged hair follicles cause bumps. Treatments are available to help manage the condition, but there is no cure. Since there is no cure, the goals of treatment are to reduce symptoms, relieve pain, and heal wounds to prevent infection.1

Treatment for HS often includes the use of injected or oral (taken by mouth) corticosteroids. Corticosteroids (sometimes just called steroids) are synthetic hormones that calm the immune system and reduce inflammation.2

How do corticosteroids work?

Corticosteroids work by reducing inflammation. Corticosteroids are similar to the anti-inflammatory hormone cortisol, which your body naturally produces in the adrenal glands. Corticosteroids also suppress the immune system, which can help control conditions that cause your immune system to attack its own healthy tissues by mistake.3

What kinds are used for HS?

There has not been much research on the use of corticosteroids for HS. However, there is some evidence that systemic (medicines that work throughout the entire body) corticosteroids may help with severe HS symptoms.4

Guidelines recommend:5

  • Short-term steroids as rescue therapy for HS flares or as a bridge to other long-term therapy
  • Long-term steroids should be tapered to the lowest possible dose in severe disease when other therapy is not enough

Corticosteroids for HS may be given by injection (intralesional) or taken by mouth (oral).

Intralesional corticosteroids for HS

Triamcinolone is the most commonly used intralesional corticosteroid for HS. A small amount of triamcinolone injected into an early HS lesion (sore) may quickly reduce inflammation from an acute flare. The injection also helps control nodules and sinus tracts that have not responded to other treatments.4,6

A triamcinolone injection relieves pain fast. It reduces redness, swelling, pus, and lesion size in a few days. It may be used alone or along with oral medications that affect the whole body. The injections can be repeated every 2 to 3 weeks if needed. However, they should be stopped or avoided if there is sign of infection in any lesions.4,5,7,8

Oral corticosteroids for HS

Limited research shows quick HS response to 3 oral steroids:4,6

  • Hydrocortisone
  • Dexamethasone
  • Prednisolone

They may be used alone or in combination with another hormone or antibiotic.4,6

What are the possible side effects?

Side effects of corticosteroids vary depending on the drug, its dosage, and how it is taken (oral, injected). Some of the common side effects of corticosteroids include:9

  • Indigestion or heartburn
  • Increased appetite, which could lead to weight gain
  • Difficulty sleeping
  • Changes in mood and behavior
  • Increased risk of infections, especially chickenpox, shingles, and measles
  • High blood sugar or diabetes
  • Weakening of bones
  • High blood pressure
  • Cushing’s syndrome
  • Eye conditions, such as glaucoma and cataracts
  • Mental health problems, such as depression

These are not all the possible side effects of corticosteroids. Talk to your doctor about what to expect or if you experience any changes that worry you.

Things to know

Rebound flares may occur when steroids are stopped. Caution should be used when a woman with HS is pregnant because of the risk to her unborn baby.4

Because of side effects, corticosteroids should be taken as short a time as possible. Most side effects go away after the treatment stops.1,7

Potential drug interactions include the antibiotics erythromycin, clarithromycin, and rifampin. Before taking any corticosteroids, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.4

Corticosteroids are just 1 part of HS treatment. You should discuss the risks and benefits of these drugs with your doctors, as well as any other steps you should take to avoid side effects. Other approaches may include different drugs, surgery, diet and lifestyle changes, and alternative medicine.

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Written by: Ina Fried and Heather Morse | Last reviewed: July 2021