Treatment - Topical and Intralesional Therapies

Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease. It begins when clogged hair follicles cause bumps that lead to abscesses, lesions, and inflammation.1

Treatments are available to help manage HS, but there is no cure. Since there is no cure, the goals of treatment are to reduce symptoms, relieve pain, and heal wounds to prevent infection.2

Topical medicines are often used to treat the symptoms of HS. Topical treatments are medicines that are applied to the skin. In many cases, they are combined with other treatments, like intralesional (injected) medicines, to effectively treat symptoms.

How do topical treatments work?

Applying topical therapies allows the treatment to penetrate the skin. Topical medicines treat pain, itching, or other symptoms. They can also be used to nourish the skin and protect it from harm.3

Some topical medicines are used for local treatment (in the areas where it is applied), while others are used to affect the entire body after they are absorbed into the skin.3

Topical medicines come in different forms, including:3

  • Creams, lotions, and foams
  • Gels, tinctures, and powders
  • Pastes, ointments, and oils
  • Sprays and patches

Examples of topical and intralesional treatments for HS

Topical treatments for HS vary greatly. They can range from over-the-counter cleansers to ointments and creams that work to control HS symptoms.

Topical antibiotic treatments for HS

Clindamycin is the only topical antibiotic studied for use in HS. In a rigorous test, people with mild to moderate HS were treated with topical clindamycin 1 percent or placebo (inactive substance). All the study participant ratings for clindamycin were better than those for placebo. It was most effective on lesions at the surface of the skin. It had little or no effect on deep lesions and abscesses.4,5

Topical resorcinol for HS

Resorcinol 15 percent is an antiseptic cream that softens and sheds scaly skin. In a research study, women with mild to moderate HS applied resorcinol twice a day for flares and daily between flares. It reduced pain and duration of abscesses but caused skin irritation. All the women reported improvement.4,5

Topical cleansers for HS

Experts caution people with HS to wash gently without friction. They also support the use of benzoyl peroxide and chlorhexidine as antiseptic cleansers. In the past, experts recommended triclosan as an antiseptic cleanser to reduce odor. But in 2017, the U.S. Food and Drug Administration (FDA) banned use of triclosan in antiseptic soaps because of concerns about its safety with long-term use. Substances that fight bacteria, like antiseptics, may disrupt hormones and promote bacterial resistance to antibiotics.4,6,7

Topical analgesics for HS

Topical analgesics help control HS pain on well-defined areas of the body. Chilling them in the refrigerator may strengthen their effects. Several medicines may be used topically, including:8,9

  • Diclofenac gel 1 percent – This nonsteroidal anti-inflammatory drug (NSAID) is recommended as the first-line topical drug for HS pain on the skin. Research shows it is safe and effective for treating acute pain for at least 1 week. It has fewer side effects than oral NSAIDs.
  • Lidocaine (Xylocaine®) ointment 5 percent – This numbing drug works immediately to control pain and lasts 1 to 2 hours.
  • Combinations – When combined with each other or with other drugs, topical analgesics often relieve pain better and for a longer time.

Intralesional treatments for HS

Intralesional treatment is the name for injecting steroids directly into lesions or into the top layers of the skin. This helps deliver the medicine more directly to the lesions compared to topical treatments. Injections of a steroid called triamcinolone have been shown to help people with HS.4,10

What are the possible side effects of topical treatments?

Side effects can vary depending on the specific drug you are taking. Common side effects of topical treatments include:4-9

  • Burning, itching, redness, rash, or swelling where the medicine was applied
  • Changes in skin color where the medicine was applied

Other less common side effects include:4-9

  • Abdominal pain, diarrhea, nausea, or vomiting
  • Blurred vision
  • Dizziness
  • Drowsiness
  • Dry mouth
  • Headache

If too much lidocaine is absorbed into the skin, it can cause serious or fatal side effects. Signs of lidocaine overdose include uneven heartbeat, seizure, and slowed or stopped breathing.8,9

Possible side effects of intralesional treatment include:10

  • Pain, bleeding, or bruising
  • Infections
  • Allergic reactions

These are not all the possible side effects of topical and intralesional therapies. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking these drugs.

Things to know about topical treatments

Topical medicines are part of a complex strategy to heal HS wounds, relieve pain, and improve quality of life. Before beginning treatment for HS, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.

Topical and intralesional therapies are just one part of HS treatment. Other approaches may include different drugs, surgery, diet and lifestyle changes, and alternative medicine.

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Written by: Ina Fried and Juliette Daly | Last reviewed: August 2021