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 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, infection, tunnels under the skin, and scars.^1,3

HS is a complex disease that is difficult to treat, and not every treatment will work for everyone with HS. More research is still needed to understand the best way to treat HS. But there are medicines that may be able to help treat symptoms. The goal of these drugs is to:⁴

• 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 drugs 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. Topical dapsone is another antibiotic that experts believe can help treat HS, but there is no clinical evidence of this.
• Steroids – Triamcinolone injected into inflamed lesions reduces redness, swelling, pus, and size of the lesion.
• Resorcinol – 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 chlorhexidine, benzoyl peroxide, and zinc pyrithione. In the past, they recommended triclosan to reduce odor. In 2017, the U.S. Food and Drug Administration (FDA) banned the use of triclosan in antiseptic soaps.
• Analgesics (painkillers) – Topical analgesics, such as lidocaine, help control pain.

Antibiotics for HS

Repeated or long-term treatment with antibiotics helps prevent the recurrence of HS. The benefit must be balanced against the risk of antibiotic resistance. Medical guidelines recommend:^1,4

• Tetracyclines, such as doxycycline, for mild-to-moderate HS is the initial recommended oral treatment therapy for HS
• Clindamycin combined with rifampin if a tetracycline is not effective or in severe disease
• Moxifloxacin, metronidazole, and rifampin in combination in cases that are unresponsive to other treatments
• Dapsone as long-term maintenance treatment in mild to moderate HS, or if a tetracycline is not effective
• 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. Medicines include:^1,4,8

• Colchicine combined with minocycline in mild to moderate disease that does not respond to other treatments.
• Cyclosporine in moderate to severe refractory 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 biologics Humira® (adalimumab) and Cosentyx® (secukinumab) are 2 FDA-approved treatments for moderate to severe HS in adults. Biologics are drugs made from living cells. They block tumor necrosis factor (TNF) or other interleukin (IL), which are proteins secreted by the immune system that increase inflammation.^10-13

Biologics used in HS include:^4,12,14,15

• 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 may show 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 A, retinoids are more effective against acne than against HS. Some retinoids that may be helpful in treating HS include:^4,16

• Isotretinoin
• Acitretin

Hormonal therapies for HS

Research shows that androgens (male hormones) may contribute to and worsen HS in women, as shown by changes related to pregnancy and menstrual cycles. Hormonal therapies include:^4,17,18

• Estrogen-containing birth control pills – Showed improvement in a rigorous test
• Anti-androgen therapies – Showed improvement; block the effects of androgen
• Metformin – A drug that treats type 2 diabetes; notable improvement mostly in women with polycystic ovarian syndrome (PCOS)
• Finasteride – A drug that treats enlargement of the prostate gland in men; helpful in limited research
• Spironolactone – A drug that treats high blood pressure and blocks androgen receptors; helpful in limited research

NSAID pain relievers for HS

Medical guidelines for the treatment of HS recommend the 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.^7,19