Treatment - Non-Steroidal Anti-Inflammatory Drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are some of the most widely used drugs for pain and inflammation. Both oral (taken by mouth) and topical (applied to the surface of the skin) NSAIDs are often used as a first-line treatment to help relieve the symptoms of hidradenitis suppurativa (HS).1

Many NSAIDs are available as over-the-counter medicines, meaning you do not need a prescription for them. However, higher strength NSAIDs that may be needed to help relieve the severe pain and inflammation of HS are only available with a prescription. Studies have found that 90 percent of people with HS experience pain that interferes with their daily activities.2

Despite the fact that severe pain is common in HS, there has not been much research on the use of NSAIDs to treat the pain and inflammation that occur with the condition. One study found that topical NSAIDs are safe and effective for treating acute HS pain for at least a week.3,4

Several studies show that topical NSAIDs have fewer side effects than oral NSAIDs. However, oral NSAIDs have a far greater effect on the whole body than topical ones. Higher doses and long-term use of NSAIDs may cause side effects like stomach or kidney problems. Although NSAIDs may help relieve the pain and inflammation of HS, they are not the best choice for all people.5,6

People with HS may have to try more than 1 NSAID to find relief from their symptoms. Some studies show that combining topical and oral NSAIDs may increase their effect in people with HS. To increase pain control, NSAIDs may sometimes be taken along with acetaminophen or with anticonvulsants, such as pregabalin or gabapentin, which help to relieve nerve pain. However, you should talk to your doctor about what treatment is best for you.5,6

How do NSAIDs work?

NSAIDs reduce inflammation, fever, and pain. Some NSAIDs, like ibuprofen, block 2 enzymes in the body, COX-1 and COX-2. NSAIDs like celecoxib block COX-2. COX-2 inhibitors usually do not cause as many gastrointestinal side effects. However, doctors usually recommend avoiding celecoxib for HS because it has a higher cardiovascular risk than other NSAIDs.5,6

What kinds are taken for HS?

Oral (taken by mouth) and topical (applied to the surface of the skin) NSAIDs are used to treat the pain and inflammation of HS.

Oral NASAIDs

Oral NASAIDs available over the counter (without a prescription) include:1

  • Aspirin (Bayer, Bufferin, Ecotrin, Excedrin)
  • Ibuprofen (Advil, Motrin, Nuprin)
  • Naproxen (Aleve and Naprosyn)

Oral NSAIDs available with a prescription include:1

  • Celecoxib (Celebrex)
  • Indomethacin (Indocin, Indocin SR, Tivorbex)
  • Ketorolac (Toradol)

Topical NSAIDs

Topical NSAIDs available with a prescription include:1,4

  • Diclofenac (Volataren, Cataflam, Zipsor)
  • Ketoprofen

What are the possible side effects?

NSAIDs can cause unwanted side effects. Possible side effects include:7

  • Stomach ulcers
  • Upset stomach
  • High blood pressure
  • Fluid retention, causing swelling around the lower legs, feet, ankles, and hands
  • Kidney problems
  • Heart problems
  • Rashes

Long-term use of NSAIDs has been associated with a slightly higher rate of heart attacks and strokes. Although these side effects can occur at any time, the risk of side effects increases with higher doses and long-term use.7

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

Other things to know

NSAIDs are safe and effective when used as directed. However, misuse can be extremely harmful. Follow your doctor’s directions when taking NSAIDs, and do not change your dose without talking to your doctor first.

You should discuss the risks and benefits of NSAIDs with your doctor, as well as any other steps you should take to avoid side effects.

Before taking NSAIDs, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

NSAIDs 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.

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Written by: Ina Fried and Heather Morse | Last reviewed: July 2021