What Are the Treatment Goals for Hidradenitis Suppurativa?

Since hidradenitis suppurativa (HS) does not have a cure, the goals of treatment are making this painful disease bearable and preventing it from becoming worse.^1,2

HS is a chronic inflammatory skin disease. The disease begins when clogged hair follicles cause bumps. Over time, this leads to symptoms like abscesses, inflammation, and sinus tracts (tunnels under the skin).^1,3

Goals of HS treatment are to:¹

• Reduce symptoms
• Relieve pain
• Heal wounds to prevent infection

Treatments for reducing HS symptoms

The aim is to prevent new lesions and to reduce the extent and progress of the disease. Medical guidelines recommend that treatments include a mix of:⁴

• Medicines
• Procedures
• Lifestyle changes
• Complementary and alternative medicine

Medicines for HS symptoms

There is a wide range of medicines that may be used to reduce flares, manage pain, and improve your quality of life. These drugs include:^5,6

• Antibiotics to prevent infections
• Corticosteroids to reduce inflammation
• Hormones to reduce the effects of androgen (male hormone) that may contribute to development of HS symptoms
• Retinoids (vitamin A-based medications) to reduce inflammation and heal lesions
• Biologics (drugs derived from living material) to reduce inflammation
• Topical and intralesional therapies to heal wounds, and soften and shed scaly skin

Procedures for HS symptoms

Several procedures or surgeries may help reduce symptoms and prevent new lesions, including:^7-9

• Nd:Yag laser (neodymium-doped yttrium-aluminum-garnet laser) designed for hair removal to decrease severity of lesions
• Carbon dioxide laser to cut out or vaporize affected skin
• Deroofing to remove the top layer and contents of an abscess
• Local excision to cut out a lesion or abscess
• Wide surgical excision (or carbon dioxide laser) to cut out or evaporate an abscess or sinus tract with surrounding tissue to be sure all diseased tissue is removed
• Negative-pressure wound therapy to shorten time required for healing

Lifestyle changes for HS symptoms

Depending on your symptoms, some lifestyle changes can reduce and help prevent HS flares. Avoiding certain foods can help ease flares, while loose clothing can help prevent irritation of lesions from friction. Smoking and obesity increase HS severity, so taking steps to stop smoking or lose weight are important.^4,7

Complementary and alternative medicine for HS symptoms

Different complementary and alternative medical treatments help some people with HS reduce flares and manage pain. These therapies include manuka honey used on dressings for wound healing and vitamin supplements to reduce inflammation. It is important to talk to your doctor before starting any type of treatment.⁷

Treatments for relieving HS pain

Pain is the most disabling factor in HS. HS pain can cause disability that impacts work, social and leisure activities, and sleep. Pain is an important cause of reduced quality of life in people with HS.^10,11

Guidelines recommend a treatment plan that includes care from a variety of healthcare professionals, including dermatologists, pain specialists, and psychologists.^7,11

Treatments may include therapy and medications to treat both acute and chronic pain. Topical painkillers and oral nonsteroidal anti-inflammatory drugs like aspirin and ibuprofen are often used for acute pain. Opioids and anticonvulsants for nerve pain are sometimes used for chronic pain, though they should be used with caution.⁷

Treatments that heal wounds to prevent infection

Open wounds may become infected with bacteria. Experts generally agree that bacteria may cause some of the destructive processes in the chronic, relapsing lesions of severe HS. These processes include odor, pus, severe scars, and decreased mobility. Infections may rarely lead to:^12-17

• Repeated cellulitis – spreading skin infection
• Septicemia – serious, sometimes fatal, infection in the bloodstream
• Epidural abscess – rare infection in the area between the bones of the skull or spine, and the outer covering of the brain and spinal cord
• Sacral osteomyelitis – painful bone infection at the base of the spine

To heal wounds, doctors usually recommend a mix of local wound care and oral antibiotics. Antiseptic washes, negative-pressure wound therapy, and antibiotics applied to the surface of the skin or injected into wounds are helpful for local wound care. Oral antibiotics are another measure to prevent infection.^5,7