Treatments for Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a chronic condition that can impact quality of life. In HS, the hair follicles are blocked, causing small painful bumps to form under the skin. These bumps can grow and become sores. They also may start to connect under the skin, causing narrow tunnels.^1,2

Treatment for HS can be complex and vary from person to person. There is no known cure for HS. Treatment is aimed at helping symptoms, reducing pain, and healing wounds.^1,2

HS treatments based on stages of severity

HS treatments often depend on the severity of the disease. The Hurley system is used to classify HS. It classifies HS into 3 stages:^3,4

• Stage 1 – One or more sores (abscesses), without tunneling and scarring.
• Stage 2 – Recurring sores with tunnelling and scarring. The sores are widely separated.
• Stage 3 – Widespread sores that occupy a large area of skin with multiple interconnected tunnels, sores, and scarring.

Treatment guidelines depend on the stage, but all stages are initially treated with topical antibiotics. Your doctor will determine the best treatment course based on your HS stage:^3-6

• Stage 1 – Medication therapy starting with topical antibiotics such as doxycycline. Hormone therapy and steroid injections may also be considered.
• Stage 2 – Medication therapy with antibiotics and hormone therapy. If no improvement, then surgery to cut out the lesion or abscess may be needed.
• Stage 3 – Drug treatments with antibiotics, hormone therapy, and biologics. If there is no response to treatment, then surgery that is wide enough to cut out the affected skin and some healthy skin to be sure that all diseased tissue is removed may be needed.

Drugs for HS

There are several different types of drugs that may be used for HS, including:^1-7

• Oral antibiotics – Antibiotics such as Monodox® (doxycycline) and Cleocin® (clindamycin) may be used to treat HS. Combinations of antibiotics may also be used. Some antibiotics applied to the skin may also help.
• Biologics or biosimilars – These drugs target the immune system to fight disease. Biologics for HS include Humira® (adalimumab), Remicade® (infliximab), Cosentyx® (secukinumab), Stelara® (ustekinumab), or Wezlana® (ustekinumab-auub).
• Hormone therapy – These medicines may help some people with HS. Some hormone drugs for HS are Aldactone® (spironolactone), cyproterone acetate, metformin, and finasteride.
• Steroid injections – Steroids injected into bumps or sores may reduce swelling and inflammation.
• Retinoids – These are vitamin A-based drugs that may help with HS symptoms. One example is Soriatane® (acitretin).

Surgery or procedures for HS

Surgery can be effective for removing tunneling, bumps, or sores. There are many different procedures, and the right one for you depends on your condition. Possible procedures or surgeries include:^1-3

• Deroofing surgery – This involves entering tunnels and removing the top skin layer to expose the tunnels. This allows for better drainage and healing.
• Punch debridement – A circular cut in the skin to remove a single lump. It may also be called limited deroofing.
• Wide local excision – This involves removing all of the affected skin. You may need a skin graft to close the wound afterward.
• Incision and drainage – A small cut is made into the affected area to allow for drainage of an infected area and provide pressure relief. This is not usually recommended because the sores will come back. But this procedure may be used for pain relief in serious cases of HS.

Laser and light therapies

Laser and light therapies target hair follicles, bacteria, and sebaceous glands to reduce HS flare-ups and decrease the size of lesions. The types of lasers used may be a carbon dioxide laser or a Nd:YAG laser. The most common side effect is pain in the treated area. People with HS reported that laser/light therapy significantly improved their lesions.⁶

Complementary and alternative medicine for HS

Complementary and alternative medicine (CAM) are treatments outside traditional medicine. Research on CAM treatments and HS is limited. Some CAM treatments that may help with HS include:^2,3

• Zinc supplements
• Eating a diet that does not include dairy, red meat, and processed foods
• Avoiding foods that contain certain types of yeast
• Vitamin D supplements

Tell your doctor about any CAM treatments you are interested in. They can interact with prescription drugs. Additionally, CAM treatments are not regulated in the same way as other drugs.^2,3

Lifestyle changes for HS

Lifestyle changes can help prevent HS from worsening. These changes include:^2,3

• Maintaining a healthy weight
• Quitting smoking
• Avoid shaving any affected skin
• Gently wash your skin every day with your hands, not a washcloth. Using an antiseptic wash may also help.

Pain management with HS

Most treatments for HS are aimed at controlling skin symptoms. However, the condition can be very painful. Warm compresses may reduce swelling on the affected skin. You can also talk with your doctor about pain relievers. They may recommend over-the-counter drugs or topical numbing creams. In severe cases, they may prescribe opioids.^2,3

Before beginning treatment for HS disease, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.