Treatment Overview
Living with Hidradenitis Suppurativa (HS) can be a deeply isolating and painful experience. The condition causes recurring, painful lumps and abscesses in sensitive areas where skin rubs together, often leading to discomfort, scarring, and emotional distress. Beyond the physical pain, the unpredictable nature of flare-ups can disrupt work, relationships, and daily confidence. Treatment is vital not only to relieve immediate pain and heal existing wounds but also to prevent the disease from progressing to more severe stages that involve tunneling under the skin.
Because HS ranges from mild cases with occasional bumps to severe forms with widespread scarring, there is no single treatment that works for everyone. A dermatologist will tailor the care plan based on the severity of the lesions and the patient’s medical history (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023).
Overview of treatment options for Hidradenitis Suppurativa
The primary goals of treating HS are to clear up current breakouts, reduce inflammation, and prevent new lumps from forming. While there is currently no cure, effective management can control symptoms and significantly improve quality of life.
Treatment strategies generally rely on a combination of medications and lifestyle modifications. For mild cases, topical treatments and home care such as warm compresses and antiseptic washes may suffice. However, moderate to severe cases usually require systemic medications to calm the immune system. In advanced stages where tunnels or extensive scarring have formed, surgical procedures like unroofing or excision may be necessary alongside medical therapy to remove damaged tissue.
Medications used for Hidradenitis Suppurativa
Doctors prescribe various medications to tackle the infection, inflammation, and hormonal imbalances that drive HS.
Antibiotics: Antibiotics are the most common first-line treatment. For mild cases, topical liquids like clindamycin are applied directly to the skin. For more widespread or moderate disease, oral antibiotics such as doxycycline or rifampin may be prescribed for several months. Clinical experience suggests that these medications help reduce drainage and pain, often showing improvement within a few weeks.
Biologics: For moderate to severe HS that does not respond to antibiotics, biologic drugs are the standard of care. Medications like adalimumab target specific parts of the immune system. These are typically administered via injection. Patients can expect a reduction in the number of inflammatory nodules and abscesses, though it may take a few months to see the full benefit.
Hormonal Therapies: Since hormones can influence HS, medications that regulate hormonal activity are often helpful, particularly for women. Spironolactone and certain oral contraceptives (birth control pills) are commonly used to prevent flare-ups associated with the menstrual cycle.
Corticosteroids: To treat painful, swollen nodules quickly, dermatologists may inject corticosteroids directly into the lesion. This can rapidly reduce pain and swelling within a few days. Short courses of oral steroids may also be used to calm a severe flare.
How these medications work
The medications used for HS target the underlying causes of inflammation and bacterial overgrowth.
Antibiotics work in two ways for HS. First, they reduce the bacterial load on the skin preventing secondary infections in the clogged hair follicles. Second, and perhaps more importantly, many antibiotics have anti-inflammatory properties that help calm the immune response in the skin.
Biologics act as precision blockers. In HS, the immune system overproduces certain proteins (like TNF-alpha) that cause massive inflammation. Biologics bind to these proteins and neutralize them, stopping the signal that leads to swelling and pus formation.
Hormonal therapies work by blocking androgens (male hormones), which are known to contribute to pore clogging and inflammation in the skin follicles.
Side effects and safety considerations
Long-term medication use requires monitoring to ensure safety.
Antibiotics can cause stomach upset, sun sensitivity, and yeast infections; long-term use risks resistance. Biologics suppress the immune system, raising the risk of serious infection, often requiring pre-treatment tuberculosis screening.
Hormonal therapies (e.g., spironolactone) require periodic blood tests due to effects on potassium and blood pressure. Oral retinoids, sometimes used for HS, are strictly avoided in pregnancy due to high birth defect risk. Seek immediate care for severe infection signs like high fever, chills, or spreading redness.
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- American Academy of Dermatology. https://www.aad.org
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov
- Mayo Clinic. https://www.mayoclinic.org
- MedlinePlus. https://medlineplus.gov
Medications for Hidradenitis Suppurativa
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Hidradenitis Suppurativa.