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Table of Contents
Determining Treatment
Home Remedies/Lifestyle
OTC Therapies
Prescription Medicine
Surgeries and Procedures
CAM
Frequently Asked Questions
Next in Hidradenitis Suppurativa Guide
Treatinghidradenitis suppurativa(HS), a chronic skin condition, often requires managing both the physical symptoms and the emotional ones.
Without treatment, it can lead to seriouscomplicationssuch assquamous cell carcinoma(a type of skin cancer), a bacterial skin infection calledcellulitis. There is an association betweenCrohn’s diseaseand HS, but HS does not lead to Crohn’s disease.
DermNet / CC BY-NC-ND
This article details treatment options, including self-care measures, medications for relieving pain and inflammation and preventing infection, and alternative therapies which, although unproven, you might find worth trying. It also explains how doctors determine what to prescribe.
1:53Click Play to Learn All About Hidradenitis Suppurativa
1:53
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Treating hidradenitis suppurativa can be complicated. Symptoms can vary widely, and not everyone experiences the disease in the same way.
Doctors make decisions about which treatments to try based on the Hurley staging system.
This system describes three distinct phases of HS—from least to most severe—and the medical treatments most likely to be effective for each, each of which are covered in-depth as you read on.
Home Remedies and Lifestyle
An important aspect of living with hidradenitis suppurativa involves protecting skin and treating breakouts. Equally important is adopting habits or making certain changes that lower the risk of flareups.
This applies regardless of the severity of your case.
Skin Care
To protect your skin, help prevent breakouts, and/or keep them from getting worse:
Caring for Wounds
Bleach Baths
If you develop a chronic bacterial infection as a result of your hidradenitis suppurativa, soaking in a highly diluted bleach bath may help kill the bacteria and prevent future infections.The bacteria that most often causes chronic skin infections in people with HS isStaphylococcus aureus,also known asstaph.
Bleach baths can sting or burn your skin. They can also dry it out. It’s important to carefully followinstructions for taking a safe bleach bathand to apply a generous layer of moisturizer to your entire body after your soak.
Before you take a bleach bath, however, ask your doctor for guidance. They can guide you on best practices for you. Also note that if you have asthma, you may be told to avoid trying this remedy. Inhaling bleach fumes may trigger an attack.
Dietary Changes
Certain foods have been found to worsen HS symptoms. If any of these are a regular part of your diet, you may want to avoid them for a time to see if your skin clears up:
Brewer’s yeast also has been linked to HS. In studies, people with hidradenitis suppurativa who avoided brewer’s yeast for a period of time and then ate foods containing it had immediate flare-ups.Brewer’s yeast is found in baked goods such as bread as well as fermented foods and beverages, including vinegar, pickled foods, beer, and wine.
Keep in mind, too, that if you’re dealing with HS, what youdoeat may be as important as what you don’t. For example, there’s evidence that following the Mediterranean diet, which is rich inantioxidants, vitamins, and minerals, may reduce inflammation and help prevent HS flare-ups.
Foods to focus on include:
Don’t Smoke
There’s a strong link between cigarette smoking and hidradenitis suppurativa. If you smoke, you may have fewer flare-ups and less severe symptoms. Kicking the habit also may help your medications work better.
It can be hard to give up smoking, but there are lots of ways to do it, including quitting cold turkey, nicotine replacement therapy, and prescription medications.
Your doctor can help you find the best approach for you.
Maintain a Healthy Weight
Extra pounds can increase the risk of hidradenitis suppurativa and make symptoms worse, especially in skin folds that can trap sweat and cause friction.
Beingobeseor overweight also places extra stress on the body as a whole, which increases the risk of inflammation.
Weight loss can help improve HS in the long term. Research has shown that dropping 15% of your total body weight is enough to improve symptoms.
Besides cutting calories, regular exercise can play an important role in shedding weight. If you have HS, though, chafing and sweat can make it hard to work out.
These tips may help:
RecapSelf-care measures like proper skin care, dietary changes, and quitting smoking are important to managing HS. Maintaining a healthy weight can also help reduce symptoms.
Recap
Self-care measures like proper skin care, dietary changes, and quitting smoking are important to managing HS. Maintaining a healthy weight can also help reduce symptoms.
Over-the-Counter Therapies
You may be able to relieve mild pain and inflammation with over-the-counter (OTC) drugs and skincare products from your local pharmacy.
Pain Relievers
Non-steroidal anti-inflammatory drugs (NSAIDs)are the most common type of OTC pain reliever. NSAIDs that come in pill form include aspirin*, Motrin (ibuprofen), and Aleve (naproxen).
Tylenol (acetaminophen) is also an effective OTC pain reliever, but it does not decrease inflammation and may not be the best choice for long-term treatment. Taking too much Tylenol in one sitting or over time has been linked to hypertension, kidney damage, and liver damage.
*Aspirin should never be given to children due to a risk of Reye’s syndrome.
Antibacterial Cleansers
Washing with an antibacterial cleanser daily can reduce bacteria on the skin and prevent inflamed lumps and boils from getting worse, help heal wounds, and minimize the odor HS can cause.
Antibacterial washes commonly used to treat HS include those that contain:
Sometimes these products cause skin to become red and dry. If you develop these side effects, ask your doctor to suggest a product that will be less irritating to your skin.
If OTC treatments aren’t effective, there are prescription-strength options that may work better to prevent and control hidradenitis suppurativa symptoms.
Antibiotics
Both oral and topical antibiotics may be prescribed to destroy bacteria that can cause infections.
Oral antibiotics for treating hidradenitis suppurativa includeoral tetracyclines, which most often are prescribed for mild to moderate cases. If these don’t work or symptoms are severe, oral clindamycin along with another antibioic called rifampin may be effective.
Topical Resorcinol
Resorcinolis what’s known as a keratolytic medication. As such, it treats hidradenitis suppurativa in a number of ways:
Resorcinol cream can be used to keep prevent or treat HS flare-ups. It’s most effective for mild cases.
Corticosteroids
Two types of corticosteroids may be used to treat hidradenitis suppurativa.
Biologics
Biologics are highly effective for treating moderate to severe HS. Most healthcare providers reserve these drugs for cases that are not improving with other treatments.
Other biologics, such as Enbrel (etanercept),Stelara (ustekinumab), and Remicade (infliximab), are sometimes prescribed off-label for HS.
Humira: Side Effects, Uses, and Risks
Hormonal Therapies
Between 44% and 63% of women with HS have flare-ups just before their periods. Women with polycystic ovary syndrome (PCOS) are particularly prone to HS.
Hormonal therapies often are effective in these cases. They include spironolactone, a medication that blocks the action of groups of hormones, andcombination oral contraceptivesthat pair the hormones estrogen and progesterone.
For adults of all sexes and children with hidradenitis suppurativa, a hormonal medication calledfinasteridemay help. This drug, which is sold under the brand names Proscar and Propecia, is also used to treat benign prostate growths and male pattern baldness.
Pregnant women should not take finasteride as it has been linked to birth defects.
Oral Retinoids
Oral retinoids, which are derived from vitamin A, sometimes work when other medications for HS don’t. They can help reduce inflammation and minimize flares even after the medication is stopped.
Absorica, Zenatane, and Myorisan (all brand names for isotretinoin) and Soriatane (acitretin) are oral retinoids that may be considered for the treatment of hidradenitis suppurativa.
WarningOral retinoids can cause life-threatening birth defects. Women who are sexually active must used two forms of birth control while taking these drugs and for up to three years after their last dose. Regular pregnancy checks are also required.
Warning
Oral retinoids can cause life-threatening birth defects. Women who are sexually active must used two forms of birth control while taking these drugs and for up to three years after their last dose. Regular pregnancy checks are also required.
Metformin
Metformin, a medication for type 2 diabetes, is sometimes prescribed off-label to relieve pain, reduce inflammation, and preventmetabolic syndromein people with HS who areat risk for diabetes.
Most people have no problem tolerating metformin, although the drug can cause diarrhea, nausea, vomiting, and abdominal pain.
RecapAlthough mild hidradenitis suppurativa often can bemanaged with home remediesand OTC treatments, prescription medications may be needed in severe cases. Some options, especially oral retinoids, cause birth defects, so it’s important to be frank with your doctor if you’re pregnant or plan to be.
Although mild hidradenitis suppurativa often can bemanaged with home remediesand OTC treatments, prescription medications may be needed in severe cases. Some options, especially oral retinoids, cause birth defects, so it’s important to be frank with your doctor if you’re pregnant or plan to be.
There are a number of ways this can be done. The goal of each is to preserve as much healthy tissue as possible.
Laser Treatments
A doctor can use any of several laser treatments during an office visit to reduce inflammation from HS,remove hair, and destroy hair follicles to help prevent new boils from forming.
Those procedures are:
It takes an average of three laser treatments before there are noticeable improvements in skin.
Deroofing
Although the treatment leaves a scar, lesions rarely come back.
Sometimes a biologic drug is prescribed before or after deroofing to suppress the immune system’s inflammatory response and help skin recover.
Incision and Drainage
When a boil becomes severely inflamed and painful, it can bedrainedwith an incision and drainage procedure. This is often done when a person goes to the hospital for emergency treatment for pain.
Incision and drainage can provide immediate relief, but won’t treat the underlying cause of hidradenitis suppurativa or prevent future flare-ups.
In most cases, HS boils that are drained do come back.
Surgical Excision
For severe cases that aren’t responding to treatment, surgery may be done to remove all tissues in the affected area. This procedure is done in the hospital undergeneral anesthesia.
There are two main methods of excision:
After excision, the skin is either left open to heal or closed with stitches. When a large area is removed, healthy skin tissues from another part of your body may be used to cover the wound. This is known as askin graft.
Removed boils are unlikely to return. However, thesurgery can leave scarsand, as with any surgery, wounds can become infected.
According to a global survey done in 2020, 80% of people with hidradenitis suppurativa have had some kind of procedure to manage their condition. Of those, 70% of people had incision and drainage, 55% had an excision, 11% had a laser treatment, and 9% had deroofing.
Complementary and Alternative Medicine (CAM)
There’s no scientific proof CAM is effective for HS, nor are CAM therapies meant to take the place of medicines or treatments.
Nonetheless, because these CAM therapies are generally considered safe and well-tolerated, they may be worth trying with a doctor’s guidance.
Zinc
Zincis a mineral that plays an important role in the health of both your skin and immune system. It also helps wounds heal.
A 2018 study published in theAmerican Journal of Clinical Dermatologyfound people with HS are more likely to havelower levels of zincin their blood than those who don’t have the condition.
While there is strong evidence that taking zinc supplements may help relieve inflammation and hidradenitis suppurativa symptoms, more research is needed before zinc can be regarded as an HS treatment.
Because the body can’t make zinc on its own, it’s important to eat foods that are rich in the mineral, such as oysters, beans, oats, nuts, whole grains, and dairy products.
The 7 Best Zinc Supplements, According to a Dietitian
Vitamin D
Like zinc,vitamin Dhelps support the immune system. Research has found a possible link between vitamin D deficiency and the onset of and severity of hidradenitis suppurativa.
In one small study of people with HS, those who tookvitamin D supplementshad a significant improvement in symptoms after six months; those who didn’t take the supplements saw no such benefit. Doses were tailored to each individual based on their blood levels of the vitamin.
Although one study is not enough to prove vitamin D is an effective way to treat hidradenitis suppurativa, making sure you get enough of this nutrient is important for overall health.
Aside from taking supplements, taking in some sun is another step you can take to boost your vitamin D. Just 10 to 15 minutes of exposure a few times a week (without sunscreen) is plenty.
You can also get vitamin D through your diet. Foods rich in vitamin D include milk, fortified orange juice, cereal, egg yolks, and fatty fish.
Summary
Hidradenitis suppurativa is a chronic skin condition that causes painful and unsightly boils. There’s no cure for the condition, but there are many effective ways to treat it.
These include gentle skin care, weight loss, avoiding foods that may trigger flare-ups, and, for people who smoke, kicking the habit.
A variety of OTC and prescription medications may also help ease discomfort, decrease inflammation, prevent breakouts, and thwart infections that can occur when boils burst and cause open wounds.
In severe cases, a doctor can remove HS lesions using laser therapy or simple surgical procedures.
A Word From Verywell
If you have visited your healthcare provider several times and the recommended treatments aren’t working, keep this in mind. Untreated, hidradenitis suppurativa gets worse over time, so it’s important to speak up if you feel your doctor isn’t taking your symptoms seriously. You should also consider getting a second opinion.
Among the known triggers for flares are:MenstruationHormone fluctuationsStressHeatSweatWeight gain
Among the known triggers for flares are:
No. HS is achronic condition. That’s why being diagnosed as soon as symptoms appear and complying with treatment are important to keeping the disease under control.
34 Sources
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Machado M, Stergiopoulos V, Maes M, et al.Depression and anxiety in adults with hidradenitis suppurativa: A systematic review and meta-analysis.JAMA Dermatol. 2019 Jun;155(8):939-945. doi:10.1001/jamadermatol.2019.0759
Kurzen H, Kurzen M.Secondary prevention of hidradenitis suppurativa.Dermatol Reports. 2019 Oct 25;11(2):8243. doi:10.4081/dr.2019.8243
Kazemi A, Carnaggio K, Clark M, Shephard C, Okoye GA.Optimal wound care management in hidradenitis suppurativa.J Dermatolog Treat. 2018 Mar;29(2):165-167. doi:10.1080/09546634.2017.1342759
Zheng K, Oakley A.Bleach baths in patients with skin infections. DermNet NZ.
Silfvast-Kaiser A, Youssef R, Paek SY.Diet in hidradenitis suppurativa: a review of published and lay literature.Int J Dermatol.2019;58(11):1225-1230. doi:10.1111/ijd.14465
Cannistrà C, Finocchi V, Trivisonno A, Tambasco D.New perspectives in the treatment of hidradenitis suppurativa: surgery and brewer’s yeast-exclusion diet.Surgery.2013;154(5):1126-30. doi:10.1016/j.surg.2013.04.018
Barrea L, Fabbrocini G, Annunziata G, et al.Role of nutrition and adherence to the Mediterranean diet in the multidisciplinary approach of hidradenitis suppurativa: Evaluation of nutritional status and its association with the severity of the disease.Nutrients. 2019 Jan;11(1):57. doi:10.3390/nu11010057
Alikhan A, Sayed C, Alavi A, et al.North American clinical management guidelines for hidradenitis suppurativa: A publication fdrom the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management.J Am Acad Dermatol. 2019 Jul;81(1):91-101. doi:10.1016/j.jaad.2019.02.068
American Cancer Society.Nicotine replacement therapy to help you quit tobacco.
Kromann CB, Ibler KS, Kristiansen VB, Jemec GB.The influence of body weight on the prevalence and severity of hidradenitis suppurativa.Acta Derm Venereol. 2014 Sep;94(5):553-7. doi:10.2340/00015555-1800
McCrae JC, Morrison EE, MacIntyre IM, Dear JW, Webb DJ.Long-term adverse effects of paracetamol - a review.Br J Clin Pharmacol. 2018 Oct;84(10):2218-2230. doi:10.1111/bcp.13656
Wipperman J, Bragg DA, Litzner B.Hidradenitis suppurativa: Rapid evidence review.Am Fam Physician.
Saunte DML, Jemec GBE.Hidradenitis suppurativa: Advances in diagnosis and treatment.JAMA. 2017 Nov 28;318(20):2019-2032. doi:10.1001/jama.2017.16691
Mundell L, Lindemann R, Douglas J.Monitoring long-term oral corticosteroids.BMJ. 2017 Nov;6(2):1-9. doi:10.1136/bmjoq-2017-000209
Kimball AB, Okun MM, et al.Two phase 3 trials of adalimumab for hidradenitis suppurativa.N Engl J Med. 2016 Aug 04;375(5):422-434. doi:10.1056/NEJMoa1504370
Theut Riis P, Christian Ring H, Themstrup L, Borut Jemec G.The role of androgens and estrogens in hidradenitis suppurativa - a systematic review.Acta Dermatovenerol Croat.
Clark AK, Quinonez R, Saric S, Sivamani R.Hormonal therapies for hidradenitis suppurativa: Review.Dermatol On J. 2017;23(10):1-7. doi:10.5070/D32310036990
University of Michigan Health.Acitretin.
National Organization for Rare Disorders.Fetal retinoid syndrome.
Verdolini R, Clayton N, Smith A, Alwash N, Mannello B.Metformin for the treatment of hidradenitis suppurativa: a little help along the way.JEADV. 2013 Sep;27(9):1101-1108. doi:10.1111/j.1468-3083.2012.04668.x
Mikkelsen PR, Dufour DN, Zarchi K, Jemec GB.Recurrence rate and patient satisfaction of CO2 laser evaporation of lesions in patients with hidradenitis suppurativa: a retrospective study.Dermatol Surg.2015 Feb;41(2):255–260. doi:10.1097/DSS.0000000000000264
Piccolo D, Di Marcantonio D, Crisman G, et al.Unconventional use of intense pulsed light.Biomed Res Int. 2014 Sep;2014(1):1-10. doi:10.1155/2014/618206
American Academy of Dermatology Association.Hidradenitis suppurativa: diagnosis and treatment.
National Organization for Rare Disorders.Hidradenitis suppuritiva.
Vellaichamy G, Braunberger TL, Nahhas AF, Hamzavi IH.Surgical procedures for hidradenitis suppurativa.Cutis.
Worden A, Yoho DJ, Houin H, et al.Factors affecting healing in the treatment of hidradenitis suppurativa.Ann Plast Surg. 2019 Oct 29. doi:10.1097/SAP.0000000000002105
Garg A, Neuren E, Cha D.Evaluating patients' unmet needs in hidradenitis suppurativa: Results from the Global Survey of Impact and Healthcare Needs (VOICE) project.J Am Acad Dermatol. 2019 Feb;82(8):366-376. doi:10.1016/j.jaad.2019.06.1301
Poveda I, Vilarrasa E, Martorell A, et al.Serum zinc levels in hidradenitis suppurativa: a case-control study.Am J Clin Dermatol.2018 Jul;19(5):771-777. doi:10.1007/s40257-018-0374-5
Dhaliwal S, Nguyen M, Vaughn AR, Notay M, Chambers CJ, Sivamani RK.Effects of zinc supplementation on inflammatory skin diseases: a systematic review of the clinical evidence.Am J Clin Dermatol.2020 Nov;21(1):21-39. doi:10.1007/s40257-019-00484-0
National Institutes of Health Office of Dietary Supplements.Zinc.
Guillet A, Brocard A, Bach Ngohou K, et al.Verneuil’s disease, innate immunity and vitamin D: a pilot study.J Eur Acad Dermatol Venereol. 2015 Dec;29(7):1347-53. doi:10.1111/jdv.12857
Skin Cancer Foundation.Sun Protection and Vitamin D.
Hope for HS.Vick’s Vapo-Rub for hidradentitis suppuritiva.
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