What Medications Treat Hidradenitis Suppurativa?
Even though hidradenitis suppurativa (HS) does not have a cure, treatments can help make this painful disease bearable and prevent it from becoming worse.1,2
HS is a chronic inflammatory skin disease with a heavy impact on the quality of life. The disease begins when clogged hair follicles cause bumps. In sporadic flares, bumps worsen and return again and again. Over time, this leads to symptoms like inflammation, tunnels under the skin, and scars.1,3
Different medicines can help treat symptoms. The goal of these drugs is to:
- Reduce symptoms
- Relieve pain
- Heal wounds to prevent infection
- Prevent new lesions
- Reduce the severity and progress of the condition
Medicines for HS disease symptoms
A wide range of medicines may be used to reduce flares, manage pain, and improve your quality of life.4
Topical and intralesional therapies for HS
These medications are applied to the surface or injected into HS lesions (sores):4-7
- Antibiotics – Clindamycin is the only topical antibiotic studied for use in HS. It is useful in mild or moderate HS but may increase drug-resistant bacteria.
- Steroids – Triamcinolone injected into inflamed lesions reduces redness, swelling, pus, and size of the lesion.
- Resorcinol is an antiseptic cream that softens and sheds scaly skin. It reduces pain and duration of abscesses but causes irritation.
- Cleansers – Experts support the use of benzoyl peroxide. In the past, they recommended triclosan to reduce odor. In 2017, the U.S. Food and Drug Administration (FDA) banned use of triclosan in antiseptic soaps.
- Analgesics (painkillers) – Topical analgesics, such as lidocaine, help control pain.
Oral antibiotics for HS
Repeated or long-term treatment with antibiotics helps prevent recurrence of HS. The benefit must be balanced against the risk of antibiotic resistance. Medical guidelines recommend:1,4
- Tetracyclines in mild-to-moderate HS
- Clindamycin combined with rifampin if tetracycline is not effective or in severe disease
- Moxifloxacin, metronidazole, and rifampin in combination in moderate-to-severe disease
- Dapsone as long-term maintenance treatment in mild to moderate HS
- Ertapenem intravenously for severe disease, as rescue therapy, or as a bridge to surgery
Immunosuppressants for HS
Immunosuppressants help calm the body’s immune system. They usually are not recommended for a pregnant or breastfeeding woman. Medicines include:1,4,8
- Colchicine combined with minocycline in mild to moderate disease that does not respond to other treatment
- Cyclosporine in moderate to severe HS when other treatments are not effective or suitable. It must be monitored for serious side effects.
Corticosteroids for HS
Corticosteroids are hormones that affect the immune system and reduce inflammation. Recommended are:1.4,9
- Short-term steroids as rescue therapy for flares or as a bridge to other long-term therapy
- Long-term steroids tapered to the lowest possible dose in severe disease when standard therapy is not enough
Biologics for HS
The biologic Humira® (adalimumab) is the first treatment approved by the FDA for moderate to severe HS in adults. Biologics are drugs derived from living material. They block tumor necrosis factor (TNF) and interleukin (IL), which are secreted by the immune system and increase inflammation.10-12
Biologics used in HS include:4,12-14
- TNF-alpha blockers
- Adalimumab is effective against HS, reduces pain, and improves quality of life
- Infliximab is recommended for moderate to severe disease
- Entanercept and golimumab need more research
- Interleukin (IL)-1 inhibitor – Anakinra shows improvement in HS symptoms
- IL-12/IL-23 inhibitor – Ustekinumab may work against HS, but it needs more research
Retinoids for HS
Derivatives of vitamin B, retinoids are effective against acne more than against HS. They include:4,15
Hormonal therapies for HS
Androgens (male hormones) affect HS in women, as shown by changes related to pregnancy and menstrual cycles. Hormonal therapies include:4,16,17
- Estrogen-containing birth control pills – Improvement in a rigorous test
- Anti-androgen therapies – Improvement; block effects of androgen
- Metformin – Drug that treats type 2 diabetes; notable improvement mostly in women with polycystic ovarian syndrome
- Finasteride – Drug that treats enlargement of the prostate gland in men; beneficial in limited research
- Spironolactone – Drug that treats high blood pressure; beneficial in limited research
NSAID pain relievers for HS
Medical guidelines for treatment of HS recommend use of nonsteroidal anti-inflammatory drugs (NSAIDs) for pain. The drugs reduce pain, fever, and inflammation. They must be monitored for side effects. Relieving pain is important in improving the quality of life for people with HS.7,18