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What Medications Treat Hidradenitis Suppurativa?

By Editorial Team · November 7, 2020

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

Medications for HS disease symptoms

There is a wide range of medicines that 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).

  • 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.4
  • Steroids – Triamcinolone injected into inflamed lesions reduces redness, swelling, pus, and size of the lesion.4
  • Resorcinol is an antiseptic cream that softens and sheds scaly skin. It reduces pain and duration of abscesses but causes irritation4
  • 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.4-6
  • Analgesics (painkillers) – Topical analgesics, such as lidocaine, help control pain.7

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

Based on vitamin A, retinoids are effective against acne more than against HS. They include:4,15

  • Isotretinoin
  • Acitretin
  • Alitretinoin

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

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

Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. 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.
  2. Vinkel C, Thomsen SF. Hidradenitis suppurativa: causes, features, and current treatments. J Clin Aesthet Dermatol. 2018 Oct;11(10):17-23. Available at http://www.ncbi.nim.nih.gov/pmc/articles/PMC6239161/. Accessed 7/26/2020.
  3. Jemec GBE. Clinical practice: Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi:10.1056/NEJMcp1014163.
  4. 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.
  5. Margesson LJ, Danby FW. Hidradenitis suppurativa. Best Pract Res Clin Obstet Gynaecol. 2014 Oct;28:1013–1027. doi:10.1016/j.bpobgyn.2014.07.012.
  6. Chen J, Hartmann EM, Kline J, et al. Assessment of human exposure to triclocarban, triclosan and five parabens in U.S. indoor dust using dispersive solid phase extraction followed by liquid chromatography tandem mass spectrometry. Journal of Hazardous Materials. 2018 Oct 15;360:623-630. doi:10.1016/j.jhazmat.2018.08.014.
  7. 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 I: Diagnosis, evaluation, and the use of complementary and procedural management. J Am Acad Dermatol. 2019;81(1):76‐90.
  8. Cyclosporine. MedlinePlus. U.S. National Library of Medicine. Available at https://medlineplus.gov/druginfo/meds/a601207.html. Accessed 8/7/2020.
  9. Steroids. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/steroids.html. Accessed 8/7/2020.
  10. Napolitano M, Megna M, Timoshchuk EA, et al. Hidradenitis suppurativa: from pathogenesis to diagnosis and treatment. Clin Cosmet Investig Dermatol. 2017;10:105‐115. doi:10.2147/CCID.S111019.eCollection 2017.
  11. Ngan V. Biological agents for psoriasis: what are biological agents? Topics A-Z. DermNet NZ. Available at https://www.dermnetnz.org/topics/biological-agents-for-psoriasis/. Accessed 8/4/2020
  12. 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.
  13. Kimball AB, Okun MM, Williams DA, et al. Two phase 3 trials of adalimumab for hidradenitis suppurativa, N Engl J Med. 2016 Aug 4;375(5):422-434. doi:10.1056/NEJMoa1504370.
  14. Mac Mahon J, Kirthi S, Byrne N, et al. An update on health-related quality of life and patient-reported outcomes in hidradenitis suppurativa. Patient Relat Outcome Meas. 2020;11:21-26. doi:10.2147/PROM.S174299.
  15. Hidradenitis suppurativa (HS): retinoids. National Health System. Available at https://www.nhs.uk/conditions/hidradenitis-suppurativa/. Accessed 7/29/2020.
  16. Metformin. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/druginfo/meds/a696005.html. Accessed 8/7/2020.
  17. Finasteride. MedlinePlus U.S. National Library of Medicine. Available at https://medlineplus.gov/druginfo/meds/a698016.html. Accessed 8/7/2020.
  18. 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.

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