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Treatment – Topical and Intralesional Therapies

Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease that begins when clogged hair follicles cause bumps that lead to symptoms like 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 medicine to the skin allows it to enter the body from there. Topical medicines are used to treat pain or other problems in specific areas of the body. 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

What kinds of topical treatments are used for HS?

Topical treatments for HS vary greatly and 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 as an antiseptic cleanser. 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 build-up indoors. Substances that fight bacteria, like antiseptics, may disrupt hormones and promote resistance of bacteria 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 medications may be used topically, including:8,9

  • Diclofenac gel 1 percent – This nonsteroidal anti-inflammatory drug (NSAID) is recommended as the first-line topical medication 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
  • Ketamine – This anesthetic affects nerve transmission. It may relieve itching, as well as pain.
  • Doxepin 3 percent or 3.3 percent – This antidepressant can relieve pain
  • Combinations – These drugs combined with each other or with other drugs often relieve pain better and for a longer time

What are the possible side effects of topical treatments?

Side effects of topical medicines vary depending on the drug and its dosage. Common side effects 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

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

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

Topical and intralesional therapies 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.

Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. Jemec GBE. Clinical practice: Hidradenitis suppurativa. N Engl J Med. 2012 Jan 12;366(2):158e64. doi:10.1056/NEJMcp1014163.
  2. 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.
  3. Using medication: Topical medications. InformedHealth.org. Available at https://www.ncbi.nlm.nih.gov/books/NBK361003/. Accessed 10/2/2020.
  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. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Scheinfeld N. Topical treatments of skin pain: a general review with a focus on hidradenitis suppurativa with topical agents. Dermatology Online Journal. 2014;20(7)1-18. Available at https://escholarship.org/uc/item/4m57506k. Accessed 8/8/2020.