Hidradenitis suppurativa (HS) is a chronic (long-term) condition that causes painful lesions under the skin.
Many people take years to get a proper HS diagnosis because it can look like pimples or acne. Without proper treatment, HS can worsen and lead to complications, including abscesses (infected, pus-filled lumps), intense pain, and sinus tracts (pus tunnels under the skin).
In severe cases, HS can make it difficult to perform everyday activities such as sitting, walking or reaching for things. HS cannot be cured, but treatment options can reduce symptoms and complications. These include medications, such as biologics, antibiotics, corticosteroids, hormone therapy, retinoids, and pain management.
Biologics are drugs made from living organisms, such as plant or animal cells, that have been engineered to produce a specific protein. Most biologic drugs target a specific part of your immune system and change its function. They treat a range of medical conditions, including moderate to severe HS.
Biologics help reduce inflammation in HS. Biologics for HS include Humira and Cosentik.
Humira (Adalimumab)
Humira is an injectable drug approved by the US Food and Drug Administration (FDA) for people 12 years of age and older with moderate to severe HS. In studies, people taking Humira had fewer abscesses and lesions than people taking a placebo.
You can inject yourself with Humira at home. The recommended starting dose for adults or children weighing 88 pounds or more is 160 milligrams on the first day. After two weeks, you will take a dose of 80 milligrams, and starting on day 29, continue with 40 milligrams every other week. Dosing for children under 88 pounds depends on their body weight.
Although Humira is an effective treatment option for moderate to severe HS, it is not suitable for everyone. Some of its side effects include headache, rash, increased risk of infections, and injection site reactions.
Cosentik (Secukinumab)
Cosentik is another FDA-approved at-home injection for moderate to severe HS in adults. The recommended dose is 300 milligrams once a week for the first five weeks, then 300 milligrams once every four weeks.
Common side effects of Cosentik include the common cold, diarrhea, and upper respiratory infections.
Other biological options
Other biologics used to treat HS include Remicade (infliximab), Kineret (anakinra), Stelara (ustekinumab), Enbrel (etanercept), Simponi (golimumab), and Bimzelk (bimekizumab-bkzk). The evidence for the use of these drugs is not as strong as for Humira or Cosentik. More research is needed to understand their effectiveness for HS and the appropriate dosage.
Health care providers may prescribe oral (taken by mouth) and topical (applied to the skin) antibiotics to treat and prevent the inflammation and bacteria that cause HS lesions.
Topical Antibiotics
Topical antibiotics, such as Cleocin (clindamycin), are effective for mild cases of HS. This medicine reduces pus-filled lesions and lumps and can help treat infection. It is usually administered twice a day, but your doctor will prescribe the best dose for you.
While cleocin was well tolerated in studies, there is a risk of antibiotic resistance in people using it long-term. The bacteria in your body can develop defenses against the drug, making it harder for the drug to clear the infection.
Oral antibiotics
Oral antibiotics are generally prescribed for moderate symptoms of HS or when topical antibiotics are ineffective. While antibiotics are usually used to clear bacteria, they are more useful in HS because of their effects on the immune system.
Commonly used oral antibiotics for HS include:
- Tetracycline antibiotics, such as doxycycline
- Rifadin, Rimactan (rifampin)
- Cleocin (clindamycin)
- Avelox (moxifloxacin)
- Flagyl (metronidazole)
- Aczone (dapsone)
- Invanz (ertapenem)
Dosage and potential side effects vary depending on the antibiotic prescribed. A typical dose of doxycycline is 100 milligrams twice a day, while moxifloxacin is 400 milligrams once a day. Healthcare professionals may prescribe oral antibiotics alone or in combination with topical treatments.
Health professionals may prescribe corticosteroid injections or pills to reduce inflammation and relieve pain.
Corticosteroid injections may be helpful for early, painful lesions that are not infected. Medicine is injected directly into the HS node to reduce swelling and pain. However, they are not effective for treating tunnels under the skin.
In addition to your existing HS treatment, your healthcare provider may consider prescribing low-dose oral corticosteroids to reduce flare-ups in severe cases.
While oral corticosteroids can work quickly to treat HS, they are not usually prescribed long-term because of potential side effects, such as high blood sugar (hyperglycemia), sleep disturbances (insomnia), and mild restlessness.
Androgens are a type of hormone known to affect HS. Therefore, hormone medications can be helpful in treating HS, especially if you experience flare-ups during menstruation or during pregnancy.
Hormone therapy can help reduce the inflammation and pain caused by HS. Examples of hormone medications used for HS include:
- Aldactone (spironolactone)
- Proscar (finasteride)
- metformin (glucophage)
- Birth control pills that contain estrogen
A doctor may only prescribe hormone therapy for mild to moderate HS. In severe cases, your healthcare provider may prescribe them along with other HS treatments. The dosage will depend on the prescribed medication. Mild stomach discomfort may occur while taking metformin.
Although not an initial treatment option, retinoids are occasionally used for HS. Retinoids support skin health and help with skin problems such as acne. Healthcare professionals may only recommend retinoids if you have both HS and acne.
Soriatan (acitretin) and Claravis (isotretinoin) are the most commonly used retinoids for HS. Isotretinoin also goes by the brand names Amnesteem, Miorisan, and Zenatane.
One risk with retinoid use is serious harm to an unborn baby if taken during pregnancy. For those who can become pregnant, your healthcare provider will likely require two pregnancy tests before you start treatment and monthly pregnancy tests during treatment.
Retinoids can also cause various side effects, such as slow-healing wounds, dry skin, hair loss, and peeling skin.
Pain relief is an important part of treating HS. One of the main symptoms of HS is painful lesions. Scars, abscesses, open cuts, friction, or other sources can also cause pain associated with HS.
Several medications can help relieve the pain associated with HS. This includes:
- Topical lidocaine
- Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen)
- Tylenol (acetaminophen)
- Anticonvulsants, such as Neurontin (gabapentin) or Lyrica (pregabalin)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), including Cymbalta (duloxetine)
Like all medications, pain relievers can cause side effects. Specific side effects depend on the prescribed medication. NSAIDs can cause stomach, heart, and kidney problems, while Tylenol (acetaminophen) can cause serious liver problems.
There are other treatment options for HS besides medication, including:
- Skin care regimen
- Laser hair removal
- botox (botulinum toxin)
- Surgical procedures
- Wound care
- Home remedies, including compresses with warm water or black tea
- Lifestyle changes, such as avoiding or quitting smoking
Health professionals often recommend a combination of treatments. This may depend on the type of lesions you have, whether pain or infection is present and whether the condition is affecting your quality of life.
If you have symptoms of HS, such as sore or pus-filled lesions where your skin rubs, it’s best to see your doctor. HS can often look like other skin conditions, such as herpes or acne, and your doctor can make an official diagnosis and recommend a treatment plan.
If you are currently receiving HS therapy but feel that your symptoms are not improving or are getting worse, or you are experiencing new or worsening side effects from your treatment, contact your doctor. They can help determine whether you need an alternative, stronger or additional treatment to manage your condition.
You should also seek care from a health care professional if you have any of the following:
- Severe pain
- Difficulty performing simple daily activities
- Changes in your mood, thoughts, or behavior
- Signs or symptoms of infection, such as fever, severe redness, or pus
In some cases, HS can increase the risk of squamous cell carcinoma (SCC), a type of skin cancer. Contact your doctor if you have a patch of skin that grows, bleeds or changes.
Hidradenitis suppurativa cannot be cured, but treatment can help treat breakouts, prevent breakouts, and reduce the risk of complications. Medications such as biologics, antibiotics, corticosteroids, and hormone therapy can help reduce symptoms.
Some people need a combination of medications to manage HS. A doctor can recommend the best medication based on the severity of the condition, medical history, and other medications.
Tell your doctor about any side effects or worsening symptoms.