If you've been diagnosed with hidradenitis suppurativa (HS), you're probably worried. The good news is that this chronic skin condition can be managed, so you feel less discomfort from the oozing bumps that appear under the skin. There’s no cure for this disease, so the goal of treatment will be to reduce flares, ease the pain, and slow down the disease’s progress so it’s
no longer controlling your life. Wherever you are in your HS treatment journey, you’re sure to have questions. We’re here to answer them. HS Treatment Frequently Asked Questions What kind of doctor should I see for hidradenitis suppurativa? Your primary
care doctor may be able to diagnose your HS, but they’ll more than likely refer you to a dermatologist for What does laser hair removal feel like? Doctors use lasers to zap hair at its roots and help reduce outbreaks of hidradenitis suppurativa. Patients say laser What can I do at home to help heal my HS? In addition to following the treatment protocol that your doctor gives, you can
watch what you eat (fewer carbs and What should I expect with HS surgery? It depends. For moderate cases (a single tunnel in one affected area ), you’ll have a procedure called deroofing, an While doctors still don’t understand what causes the painful, recurrent lesions to form, the best guess at the moment is that there seems to be some kind of defect in the hair follicles on your body. In HS, inflammation develops around follicles and causes them to eventually break open. This releases the hair shaft and normal bacteria from the follicle under the skin, which leads to more inflammation. For some reason—maybe because of faulty genes or some type of environmental trigger like hormones or chemicals—your immune system gets reprogrammed to attack these ordinarily friendly bacteria. The resulting inflammation makes it easier for bacteria to proliferate, which causes more inflammation and pus-filled nodules that look like boils. Left to run their course, these nodules grow, swell, and burst over the span of a week or two, leaking foul-smelling blood and pus from deep in the skin. These lesions can be extremely painful and take a long time to heal. In mild cases or early in the disease, people tend to have solitary nodules mainly in one area. Stage 1 is nodules coming and going without scar or tunneling. Stage 2 is when the presence of one or a few widely separated tunnels in one or multiple body areas, and 3 widespread and/or interconnected tunnels or scarring in one or multiple body regions. Stage 1 can be in multiple body areas, and stage 3 can be in only one body area. Get All the Details on Hidradenitis Suppurativa What Is the Best Treatment for HS?Doctors may try a combination of medical treatments and sometimes surgery on your hidradenitis suppurativa, depending on the type of nodules you have, how severe they are, and where they're cropping up on your body—with the understanding that what works for one person may not work for you. What’s more, HS doesn’t just affect your skin. It’s an inflammatory condition, which means there are a wide range of illnesses that often occur with it (called comorbidities)—like inflammatory bowel disease (IBD); spondyloarthritis (SpA), a form of arthritis that causes back pain; anxiety and depression; and metabolic syndrome, a cluster of risk factors that include obesity, high blood pressure, and high cholesterol that ups your risk of diabetes, strokes, and heart disease. That’s why it’s important to get a whole team of pros that can help you get everything under control—your body, skin, and soul. What Medications Are Available for HS?You will probably be on several of these medications, including the topicals, as you and your dermatologist find a way to manage your HS. Expect some trial and error. Medications can work at first, then stop working after a while, which may mean trying another, stronger one in that group (antibiotics, say). Or you may hit upon the perfect combo from the get-go. Sometimes the research on how well some of these medications perform is based on small studies and anecdotal evidence (meaning reports from patients and doctors), or your doctor’s own personal experience with HS patients. It’s tough but try to be patient—eventually you and your team of docs will find the right meds (or close to it) for you. These are some of the options you may discuss. Topicals for HidradenitisYour doctor will probably suggest you use an antiseptic body wash as well as antibacterial ointment on your nodules to control inflammation and reduce the number of bacteria on your skin. If you only have a few nodules in one area of your body, then these ointments and soaps can reduce flares to the point of remission, especially if you have laser hair removal beforehand. Antiseptic WashesThese usually contain antibiotics chlorhexidine or benzoyl peroxide (which seems to be particularly effective), and you’ll use one every day on the parts of your body affected by HS. They can break up the sticky layer of bacteria that attaches to the nodules, called a biofilm. Available over the counter, they can help control the smell from the nodules as they drain, and also prevent flare-ups. Common washes include:
AntibioticsIf your nodules are painful and swollen, then your doctor will prescribe an antibiotic ointment or lotion to put on twice a day. Topical antibiotics are used during acute flares to reduce pain and inflammation, whether you have a mild or moderate case. The most effective antibiotic lotion is Cleocin (clindamycin). KeratolyticsKeratolytics are exfoliants that help break up and loosen skin cells to reduce the size and pain of nodules in stage 1 and 2 cases of hidradenitis suppurativa. Resinol (resorcinol) is on type of keratolytic that is commonly prescribed. Systemic Medications for HSYour doctor may put you on one or several systemic medications—meaning oral or IV drugs that affect your whole body, not just the nodules themselves (like the topicals do). These include antibiotics, hormonal therapy (birth control pills, say) and biologics. Each does different things, but the goal of each is to reduce flares and pain—and, depending on which stage you’re in—even put the disease into remission. Which drug you take also depends on your other conditions. For instance, if you have polycystic ovary syndrome (PCOS) or some sort of hormonal imbalance, a doctor will probably put you on an androgen-blocker since that hormone seems to play a role in both conditions. These are a few options: AntibioticsBacteria may not cause HS, but they can make it worse, and oral antibiotics are given to help diminish their numbers when you have multiple active nodules. Doctors also prescribe them to reduce inflammation and stabilize the condition, and, when you have a severe case of HS, to keep the pain and draining pus from getting worse before starting surgery or a more heavy-hitting med like a biologic. Your dermatologist may start you on one antibiotic, usually in the tetracycline family (doxycycline or minocycline), if your HS is mild but topical antibiotics aren’t controlling it well. For more moderate or severe cases, research shows you may take a combo of clindamycin with rifampicin for at least 10 weeks—French researchers found that 300 mg of clindamycin along with 300 mg of rifampicin twice a day together improved the symptoms and quality of life for 82% of the HS patients in the study. Antibiotics come with caveats, though. Unlike ordinary bacterial infections, the antibiotics don’t clear up the condition forever. At best, they manage it until you stop taking the meds. Second, you take strong doses of these drugs for weeks and sometimes months, which can give you such side effects as diarrhea, nausea, and yeast infections. And finally, doctors are wary of using them long term, as bacteria can become resistant to them. Both surgery and biologics are better solutions in the long run. Commonly prescribed antibiotics include:
Antibiotic Side EffectsAntibiotics are generally considered safe and have been used for many years. Still, like any medication, they can affect the body in ways beyond treating HS. Common side effects for systemic antibiotics include:
Hormone TherapyEven though people with HS tend to have normal hormone levels, experts believe that androgens, the male sex hormones that include testosterone, play a role. The clues: Some female HS patients also have PCOS (another condition driven by abnormal hormones); HS usually begins after puberty (most often in your 20s and 30s) and seems to taper off after 50 when menopause hits (but not always). That’s why your doctor may put you on an androgen-blocker if your flare-ups get worse right before or during your period or you have irregular cycles. If you’re a guy losing hair in what’s called male-patterned balding (thinning on the crown with a receding hairline), you might also be a good bet for hormone therapy—it’s a sign your hair follicles are sensitive to DHT, a type of testosterone. While there’s not a lot of evidence backing their use in hidradenitis, androgen-blockers can improve or even clear up mild to moderate cases, either by themselves or in combination with other medications (like topicals). Anti-androgens include:
Hormone Therapy Side EffectsHormone therapy can affect different people in different ways. In general, these are some of the common side effects you may experience:
RetinoidsThese oral acne-fighting meds can shrink oil glands and reduce the number of bacteria in both the oil glands and on the skin, and dermatologists have been prescribing them for people with acne for years. But the evidence for how they work on HS is mixed. Nearly two-thirds of HS patients had no response when they took the retinoid isotretinoin, according to one review study. Acitretin, another retinoid, might be a better bet for improving outbreaks and pain, even though the evidence behind it is based on small sample-size studies. And if you’re a woman between the ages of 20 and 40, you may not want to take retinoids at all, as they can cause birth defects if you get pregnant. The most commonly prescribed retinoids are:
Retinoid Side EffectsIf your doctor does prescribe retinoids to treat your hidradenitis suppurativa or scars from it, you'll want to be aware of possible side effects from taking this medication. Some of the most common include:
MetforminThis drug treats high blood sugar, and your dermatologist may prescribe it if you show signs of prediabetes—or the potential to develop it—like if you have a high BMI and your lab tests come back showing higher-than-normal glucose levels. The goal with metformin is two-fold. It’ll reduce insulin resistance and lower your risk of developing type 2 diabetes and, later, heart disease. And the drug can also decrease the number of nodules and may even put you in remission. How so? Uncontrolled insulin levels can fuel inflammation, so reducing its levels can also affect flares. In one small study, two-thirds of HS patients showed improvement and 19% of those went into remission. Common brand names include Fortamet, Glucophage, Glucophage XR, Glumetza Riomet. Metformin Side EffectsA metformin prescription to manage your hidradenitis suppurativa may come with these common side effects:
BiologicsBiologics are used in a variety of autoimmune disorders to control different types of proteins that fuel inflammation. People with HS produce too much TNF-alpha (among other inflammatory proteins), so biologics called TNF-inhibitors, like Humira (adalimumab) and Remicade (infliximab), block these proteins to slow down inflammation and prevent the disease from progressing. Dermatologists tend to prescribe TNF-inhibitors in moderate-to-severe cases that haven’t been helped by other medications or to decrease the number of inflamed lesions before surgery. New research in The Journal of Dermatology found Humira to be highly effective over a one-year period at managing HS symptoms with minimal side effects. Remicade, given via an IV at the doctor’s office, has been used off-label to good results, according to study that found that after eight weeks of being treated with Remicade, patients had at least a 50% improvement in their HS symptoms and quality of life. Biologics Side EffectsDifferent biologics have different side effects, and how each person reacts to the treatment is different. Nevertheless, these are some of the common side effects you may experience if your doctor prescribes biologics to manage your hidradenitis suppurativa:
Surgery and Laser TreatmentsDoctors will use lasers (and sometimes old-school scalpels) to help control HS. In milder cases, removing hair from the armpits and groin can reduce your HS to the point of remission. In more serious cases, surgery may be the only way to control the pain and suffering when you have many tunnels. Laser Hair RemovalUsing a laser to zap hair at its roots so it grows more slowly can keep outbreaks from recurring in some parts of your body. In fact, it can reduce these outbreaks by about 70% in the groin area to roughly 75% in the armpits, say experts. This is especially true if you still have a mild case of HS, but hair removal is also helpful in moderate-to-severe cases as well if you don’t have tunnels. You’ll need to go once a month for at least three months and continue using the antiseptic washes and antibiotic lotions to keep nodules at bay. SurgeryIf your lesions have formed tunnels—inflamed areas under your skin connecting the nodules—your doctor will probably recommend surgery to remove the damaged tissue. What kind of procedure you have, though, depends on the stage of the disease. For moderate cases (a single tunnel in one affected area ), your provider performs a procedure called deroofing, an in-office procedure. You’ll be given a local anesthetic or topical anesthetic (sometimes a numbing cream followed by an injection) and then the doctor will open up the tunnel to scrape out the deep-red, jelly-like material made up of white blood cells, bacteria, and tissue. As the tunnel heals, it closes up and forms a scar, preventing nodules from erupting there again, at least in the majority of cases. For multiple, interconnected tunnels in patients who have a severe case that’s not improving with medication, doctors use a laser or scalpel to remove skin, hair follicles, and oil glands from these tunnels. This is a bigger operation, requiring general anesthesia and sometimes a hospital stay. After the operation, the wound is either closed with stitches or skin grafts or left to heal on its own, with dressings and ointments. About half of all HS patients find that the outbreaks no longer occur in those areas operated on—even though they may have outbreaks in other places. But even better, the pain level from the active lesions will go down from nine or 10 to a two or three. Other Types of Therapy That May HelpMedication and surgical intervention are not the only tools you can use to manage HS. Making small adjustments to your diet and lifestyle may help as well. If you're looking for additional approaches to ease symptoms of this condition, start here. Lose WeightConsuming fewer carbs and more protein can help reduce inflammation for everyone—and it may help you shed pounds, lowering the risk of other diseases associated with HS like heart disease and type 2 diabetes as well as improving HS symptoms, according to some studies. But besides losing weight, banning certain foods from your diet may also help with HS flares. Change Your DietIn a survey of people living with HS published in the journal Dermatology, 31% of participants reported feeling much better after eliminating certain foods from their diet. These foods ranged from dairy, gluten, and refined sugars to alcohol and tomatoes. About 76% of the participants eliminated at least one of these food groups, while 85% eliminated more than one. There’s some evidence that dairy-free diets improve symptoms for patients as does avoiding yeast-products, like beer, cider, and miso. Staying away from nightshades—tomatoes, bell peppers, eggplant, and white potatoes—has worked for others, perhaps because these plants contain solanine, a chemical which may increase inflammation. If you want to try modifying your diet, keep a log of foods to see which ones trigger or make symptoms worse. Quit SmokingSmoking is a risk factor for many chronic conditions, and hidradenitis suppurativa is no exception. According to a study in the British Journal of Dermatology, smokers are twice as likely to have HS as nonsmokers. And the American Academy of Dermatology reports that 70% to 90% of people with hidradenitis suppurativa also smoke. The likely correlation between the two? Smoking is known to increase inflammation in the body, and inflammation is both a trigger for the disease and an exacerbator of symptoms. Consider PainkillersPain is ever-present when you have HS, which is why you need a way to manage it when it gets out of hand. Your provider will probably want you to start with soothing creams and gels that contain 5% lidocaine and pain relievers like acetaminophen and ibuprofen or other nonsteroidal anti-inflammatory drugs (NSAIDs). If your lesions still hurt, then your doctor will prescribe an SNRI like duloxetine, an antidepressant that reduces pain signals to the brain, or gabapentin, an anti-convulsant that affects pain caused by nerve damage. For pain after surgery or if nothing else helps, you may take opioids like tramadol, but always under your provider’s watchful eye. Some common pain relievers include:
Try SupplementsMany people suggest turmeric, which is an anti-inflammatory, but the evidence that it can help HS flares is all anecdotal. There is slightly more scientific evidence backing zinc supplements. Taking 90 mg of zinc every day if you have a mild or moderate HS may decrease nodules to the point of remission, according to one small pilot study. That’s because zinc plays a big role in your immune system’s ability to fight off harmful substances and repair damaged cells; low levels may contribute to lesions and slow healing. Implement an HS Skin Care RoutineWhether you have one open lesion or tracts of them, you will have to become a pro at tending to your wounds so they can heal more quickly. Of course, your dermatologist can show you how, since providers have an array of products, like specialized dressings made from highly absorbent material. The best dressings are made up of three layers—the contact layer next to the open lesion, the absorbent layer that soaks up the pus and fluids, and a barrier layer to keep bacteria out. For smaller open lesions, try a sanitary pad with the adhesive side attached to your clothing, as some HS patients have done.
 Linda Rodgers Linda Rodgers is a former magazine and digital editor turned writer, focusing on health and wellness. She's written for Reader’s Digest, Working Mother, Bottom Line Health, and various other publications. When she's not What overAcne washes with benzoyl peroxide are typically available over the counter and can be useful to reduce the symptoms of hidradenitis suppurativa. However, most patients will require other treatments in addition to this.
What is the best cream for hidradenitis suppurativa?Topical antibiotics, such as clindamycin (Cleocin T, Clinda-Derm), are commonly prescribed for mild HS. They can treat infections, reduce inflammation, and prevent new lesions from forming. They may also reduce the odors that can sometimes accompany infection.
What medicine helps with hidradenitis suppurativa?Mild symptoms might be managed with a topical antibiotic in liquid or gel form. For more-widespread disease, your doctor might prescribe antibiotic pills, such as doxycycline (Monodox), clindamycin (Cleocin), rifampin (Rimactane) or both. People with severe disease might need to take antibiotics for months.
How can I get rid of hidradenitis suppurativa fast?Natural treatment options for hidradenitis suppurativa. Warm compress. A warm compress can immediately reduce pain in the affected area. ... . Turmeric. Turmeric has strong anti-inflammatory, antimicrobial, and antibacterial properties . ... . Honey. ... . Tea tree oil.. Aloe vera. ... . Rubbing alcohol. ... . Zinc. ... . Neem oil.. |
Over the counter medication for hidradenitis suppurativa
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