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Treatment – Immunosuppressants

Even though the exact cause of hidradenitis suppurativa (HS) is not known, scientists think part of the problem may be an overactive immune response to mostly harmless bacteria in the skin. To reduce that response, doctors use immunosuppressants to calm the immune system. Immunosuppressants can both reduce inflammation and relieve pain.1,2

Treatments are available to help manage HS, 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.3

How do immunosuppressants work?

Some research shows that immunosuppressants can help reduce the inflammation and pain of HS. There is still much research that needs to be done to better understand the causes of HS and the best ways to treat it.

When a person’s body senses a foreign object, the immune system attacks it. In people with HS, the immune system seems to overreact to mostly harmless bacteria in the skin. It attacks and damages the skin, causing symptoms like abscesses, inflammation, and sinus tracts (tunnels under the skin). Immunosuppressant drugs help reduce the risk of the body attacking the bacteria and damaging the skin.1,2

What immunosuppressants are used for HS?

The choice of medication used depends on the type of symptoms and their severity.

Cyclosporine for HS

A study of a small number of people with HS found that cyclosporine showed positive response. It is recommended for use in moderate to severe HS when other treatments are not effective or suitable.4,5

Colchicine for HS

Limited research shows that people with mild to moderate HS improved with a combination of colchicine and the antibiotic minocycline. The combination may be used when HS does not respond to other treatment. Colchicine alone did not show positive results in people with moderate to severe HS and is not recommended.5

Other immunosuppressants for HS

Methotrexate and azathioprine have been tried for HS. Methotrexate is used to treat severe psoriasis, rheumatoid arthritis, and some types of cancer. Azathioprine is used to prevent organ transplant rejections and to treat severe rheumatoid arthritis, Crohn’s disease, and ulcerative colitis. They did not produce positive results for HS and are not recommended for that purpose.5-7

Other immunosuppressants have been suggested as potential treatments, but they have not yet been tested.8

What are the possible side effects?

Side effects of immunosuppressant drugs vary depending on the drug and its dosage. Not everyone experiences the same side effects, and different people may experience varying levels of severity.

Some of the common side effects of certain immunosuppressant drugs include:6,7,9-11

  • Diarrhea
  • Fatigue or weakness
  • Flu-like symptoms, such as chills, fever, nausea, vomiting, and muscle/joint aches
  • Headaches
  • Heart palpitations
  • Increased risk of infection
  • Pain, redness, or soreness at the injection site
  • Swelling or weight gain

Immunosuppressant drugs increase your risk for developing infections. Since your immune system is suppressed, your body is less able to fight off infections. These drugs also increase your risk for developing certain kinds of cancer.6,7,9-11

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

Things to know

If you take immunosuppressants, your doctor will closely monitor you for signs of infection and order regular tests to watch your liver function, kidney function, and other signs of overall health. Regular cancer screenings are also recommended while taking immunosuppressants.6,7,9-11

Many immunosuppressants are not recommended for women of childbearing age. Colchicine may cause infertility in men. Talk to your doctor if you are pregnant, plan to become pregnant, or if you are breastfeeding.6,7,9-11

Potential food and drug interactions may occur with cyclosporine and colchicine. Before using any immunosuppressants, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.6,7,9-11

Immunosuppressants 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.

Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. Constantinou CA, Fragoulis GE, Nikiphorou E. Hidradenitis suppurativa: infection, autoimmunity, or both? Ther Adv Musculoskel Dis. 2019 Dec 30;11:1-14. doi:10.1177/1759720X19895488.
  2. Nazary M, van der Zee H, Prens E, et al., Pathogenesis and pharmacotherapy of hidradenitis suppurativa. Eur J Pharmacol. 2011 Dec 15;672(1-3):1-8. doi:10.1016/j.ejphar.2011.08.047.
  3. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  4. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015 Jan;29(4):619-644. doi:10.1111/jdv.12966.
  5. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91‐101.
  6. Methotrexate. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/druginfo/meds/a682019.html. Accessed 8/10/2020.
  7. Azathioprine. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/druginfo/meds/a682167.html. Accessed 8/10/2020.
  8. Van der Zee HH, Laman JD, Boer J, Prens EP. Hidradenitis suppurativa: viewpoint on clinical phenotyping, pathogenesis and novel treatments. Experimental Dermatology. 2012;21:735-739. doi:10.1111/j.1600-06225.2012.01552.x.
  9. Cyclosporine. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/druginfo/meds/a601207.html. Accessed 8/7/2020.
  10. Colchicine. MedlinePlus U.S. National Library of Medicine. 2019 Apr 15. Available at https://medlineplus.gov/druginfo/meds/a682711.html. Accessed 8/10/2020.
  11. Colchicine. National Health System. Available at https://www.nhs.uk/medicines/colchicine/. Accessed 8/10/2020.