Hidradenitis suppurativa (HS) is a chronic (long-term) inflammatory skin condition that affects up to 1% of people in the United States.In people with HS, blocked hair follicles cause inflammation and painful abscesses or lesions, usually around the armpits and groin.
Chronic and acute (sudden) pain is common in HS. There are two types of pain associated with HS: nociceptive (localized) and neuropathic (nerve) pain.
HS pain can affect a person’s quality of life, affecting their work, intimacy and mental health. There are several ways to manage pain from HS, either at home or with your doctor.
Hidradenitis suppurativa pain can be chronic or acute, and home management strategies, including over-the-counter (OTC) medicationsor lifestyle changes can help.
Although these strategies do not require medical supervision, your healthcare provider may have suggestions tailored specifically to your needs.
OTC medications
The main OTC medications used for HS are nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) and Aleve (naproxen).Oral NSAIDs are considered particularly beneficial for HS because they reduce pain by reducing inflammation. Topical NSAIDs such as lidocaine patches or menthol ointments are also an option, but can cause skin irritation.
You can also try pain relievers such as Tylenol (acetaminophen) for mild HS pain. However, pain management studies for HS have shown that NSAIDs are usually more effective due to their anti-inflammatory effects.
Before taking any over-the-counter medication on a regular basis, you should check with your doctor—especially if you have any other medical conditions—for proper dosage recommendations. If necessary, your doctor may be able to prescribe a stronger or more frequent dose.
Lifestyle changes
HS develops when inflammation blocks hair follicles. This blockage can lead to skin irritation and abscesses, which are painful, pus-filled pockets on the body.
Making the following lifestyle changes can help reduce skin and hair follicle irritation:
- Wear loose, breathable clothing
- Wash off sweat soon after exercise or exposure to a hot environment
- Shower more often to reduce inflammation
- Avoid harsh cleaning or skin products, such as scented soaps and laundry detergents
Other lifestyle changes include avoiding smoking and maintaining an optimal weight that you and your healthcare provider have discussed. Smoking increases the chances of blocked hair follicles, and obesity can increase skin friction, sweating, and hormonal changes that affect HS.
Managing HS at home is a great way to reduce pain. However, you may need additional help from your healthcare provider to manage your symptoms, especially when it comes to flare-ups.
Medicines for acute pain
There are several prescription medications used to help manage HS pain, and your doctor may prescribe different medications based on the type of pain you have.
Nociceptive (localized) pain in HS is usually acute and may feel gnawing, aching or throbbing. Some prescription medications that can help with nociceptive pain include:
- Prescription NSAIDs, such as Advil or Aleve
- Oral prescription medications such as Voltaren (diclofenac) or Celebrec (celecoxib)
- Lidocaine patches
- Menthol cream
- Steroid injections such as intralesional triamcinolone
These drugs reduce inflammation and can prevent your brain from receiving pain signals from your skin.
Medications for chronic pain
Neuropathic (nerve) pain can be the result of chronic inflammation associated with HS, which feels like a tingling, burning, or stinging sensation. For neuropathic pain, your healthcare provider may prescribe:
- Anti-seizure medications such as Neurontin (gabapentin) or Lyrica (pregabalin)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), such as Effecor (venlafaxine), which primarily treat depression and anxiety
- Tricyclic antidepressants (TCAs) such as Pamelor (nortriptyline), Norpramine (desipramine), or Amitide (amitriptyline)
These medications help reduce the pain that comes from your nerves.SNRIs and TCAs, in particular, can reduce nerve pain associated with HS. They can also reduce symptoms of anxiety and depression that are common in people with this condition.
Antibiotics
Although bacterial infections are not the primary causes of HS, they can increase inflammation and worsen pain. If your health care provider suspects infection in HS lesions, they may prescribe antibiotics to clear the infection and reduce pain.
Surgery
People with HS can develop painful lesions and abscesses that produce pus and odors. In some cases, surgery may be necessary to reduce acute HS pain caused by these lesions and abscesses. Your healthcare provider may recommend incision and drainage of these abscesses to relieve pain.
In addition to home remedies, drugs, and surgery, complementary treatment approaches can be helpful for HS pain. Your healthcare provider may suggest these approaches in addition to standard medical practices.
Acupuncture
Acupuncture is a medical treatment in which small needles are applied to specific points on the body to relieve pain. It has been useful for other conditions, such as chronic headaches and arthritis.
Radiofrequency (RF)-based selective electrothermolysis, using microneedles or acupuncture needles for epilation, is a possible treatment for HS symptoms. RF uses the electrical properties of the skin to deliver heat energy through an insulated needle, which may help reduce the need to drain HS lesions.
Acupuncture has shown benefits for some people with HS, but more studies are needed to better understand its potential effectiveness as a treatment option.
Therapy
Living with HS can significantly affect your quality of life, and many people with the condition may struggle with pain-related anxiety or depression, stigma and feelings of negative self-esteem. Therapy can be supportive and help remind and reassure you that HS is not contagious or related to poor hygiene.
A health care provider may recommend cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) in combination with treatments for HS.
Alpha Lipoic Acid (ALA)
Alpha lipoic acid (ALA) is an antioxidant produced naturally by the body. As a dietary supplement, it is commonly used for diabetic nerve pain. ALA may also help reduce nerve pain associated with HS.
Curcumin
Curcumin comes from the rhizomes (underground stems) of turmeric plants and can be taken as an herbal supplement. It is known to help reduce inflammation, which people with HS would benefit from. It can also reduce the chance of cardiovascular (heart) events such as heart attack, for which someone with HS has a higher risk.
If you’re experiencing pain that interferes with your daily activities, talking to your doctor or dermatologist (a doctor who specializes in skin, hair, and nail conditions) about treatment options is a great next step.
It can be difficult to determine when your HS symptoms warrant a visit to the doctor. The symptoms of HS can sometimes be similar to those of a skin infection. Knowing which symptoms warrant evaluation is key, especially since bacterial skin infections are quite common in people with HS.
If you have any of the following symptoms along with the pain, seek help immediately:
- Fever
- Rapid worsening of symptoms
- More purulent drainage than usual
- Redness, warmth or red streaks coming from the affected area
Pain management for hidradenitis suppurativa (HS) may include home remedies, medical treatments, surgery, and complementary approaches such as acupuncture or supplements.
OTC medications for mild pain can reduce inflammation and provide relief. Lifestyle changes, such as wearing loose-fitting clothing and avoiding irritants, help reduce attacks. For more severe pain, your healthcare provider may recommend prescription medications.
If you have HS and pain is affecting your quality of life, talk to your doctor about personalized treatment options to improve your symptoms.