Treatment for hidradenitis suppurativa (HS) varies depending on the condition’s severity. Early HS can be manageable with medication, while more severe cases may require both medication and surgery.

HS, also known as acne inversa, is a chronic skin condition that causes inflammation in areas of skin that rub together and contain sweat glands, such as the armpits and groin. The condition occurs when there is a blockage in the hair follicles, causing painful, boil-like lumps to form under the skin.

Without suitable treatment, HS can result in major scarring. Treatment usually involves reducing pain and managing the frequency and severity of breakouts. Many medications can help treat minor to moderate cases of HS. In more severe cases, a doctor may prescribe stronger drugs or recommend a surgical procedure.

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Typically, topical antibiotics are the first-line treatment for early HS because of their anti-inflammatory properties and antimicrobial effects. A person can administer this treatment directly onto their skin to help kill bacteria that may have entered the blocked gland or hair follicle, which can contribute to inflammation.

According to the United Kingdom’s National Health Service (NHS), a person will typically use a chlorhexidine wash, which they can use as a soap substitute, or a clindamycin lotion, which they can apply twice per day.

In other cases, a doctor may prescribe oral antibiotics, which a person takes by mouth. Doctors may need to prescribe different combinations, strengths, and courses of antibiotics to find an effective treatment. This may include:

When taking antibiotics, it is important to follow a doctor’s directions. This can include taking the course exactly as they prescribe, wearing clothes that protect the skin from the sun, and using sunscreen.

Researchers do not fully understand the role of hormones in HS. However, many people report that HS symptoms worsen before menstrual periods and after pregnancy. There is also a link between HS and metabolic conditions, such as diabetes, that affect blood sugar levels.

As such, some people may benefit from hormonal therapies, such as:

Possible side effects can vary depending on the hormonal therapy. For example, spironolactone can cause irregular periods, breast pain, and low blood pressure, while metformin may cause abdominal pain and diarrhea.

To help reduce inflammation, a doctor may prescibe a mild topical steroid, steroid tablets, or a steroid injection. A 2022 systematic review notes that intralesional corticosteroids (steroid injections a doctor administers directly into a lesion) can be a safe and effective treatment for HS.

According to the NHS, possible side effects of steroids can include:

  • weight gain
  • sleep issues
  • mood swings

If initial treatment is ineffective, a doctor may consider prescribing biologics or biosimilars, which are specialized medications that derive from living cells and organisms, like plant or animal cells.

Biologics or biosimilars help manage HS by suppressing specific parts of the immune system, helping reduce inflammation.

At present, two biologics have approval from the Food and Drug Administration (FDA) for treating HS. These include adalimumab, a monoclonal antibody, and secukinumab, an interleukin inhibitor.

It is important to note that because these medications suppress the immune system, people may be susceptible to infection while taking them.

If medications alone are not effective, a doctor may recommend surgery. Typically, surgical treatment is more effective in combination with medications.

A doctor may use a surgical blade, laser, or other surgical instrument to drain a painful bump or remove an abscess or lesion that keeps returning after treatment. Doctors will select the most suitable surgical option depending on the individual.

Surgery is usually an effective option for managing HS. A small 2022 study notes that many people report high satisfaction rates and rapid recovery. However, complications can occur. The study indicates that only 45% of those who underwent HS surgery progressed to primary wound healing with no complications.

After surgery, it is essential to care for the surgical wound to help prevent an infection. A doctor will provide instructions for wound care, such as regularly changing dressings and using an antiseptic wash.

According to the American Academy of Dermatology Association, the following self-care tips can help with managing HS:

  • washing skin with an antimicrobial wash
  • not scrubbing skin
  • taking care when shaving or waxing, or considering laser hair removal
  • using heat, such as a warm compress, to treat a painful lump
  • trying to avoid excessive sweating and overheating
  • using a mild and effective antiperspirant or deodorant
  • following a doctor’s guidelines for treating wounds
  • considering wearing looser fitting clothing
  • managing weight
  • stopping smoking, if applicable

Learn about HS home remedies.

Treatment options for HS may vary depending on the severity of the condition. With earlier HS, a doctor may recommend antibiotics, hormonal therapy, or steroids. In more severe cases, they may recommend biologics or surgery.

In addition to medication and surgery, people can also follow self-care tips to help them manage the condition. This can include using antimicrobial washes, warm water compresses, and an effective antiperspirant.