How Is Hidradenitis Suppurativa Treated?

Hidradenitis suppurativa (HS), also called acne inversa, is a skin condition characterized by painful lumps under the skin. The lumps, which form in hair follicles, can look like large pimples or acne. They develop on areas where skin rubs against skin, such as armpits, groin, the area under breasts, and inner thighs. Without treatment, the lumps may turn into pus-filled pockets called abscesses, which can leak and scar over.

Dermatologists (doctors who specialize in skin, hair, and nails) diagnose and treat hidradenitis suppurativa. There is no cure, but many people find relief through treatment, which includes skin care, medication, wound care, and pain relief. Treatment aims to reduce pain, heal wounds, reduce flare-ups, and prevent the condition from worsening.

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Medications 

Many medications can help treat hidradenitis suppurativa. They include:

• Topical medications: Applied directly onto your skin. Work locally, in the areas where they're applied.
• Oral medications: Taken by mouth. Work systemically (throughout your body).
• Off-label medications: Medications approved by the Food and Drug Administration (FDA) to treat other conditions (as noted on the package insert) that can help treat hidradenitis suppurativa.
  

Topical Medications

Topical medications are often the first treatment for early stages of hidradenitis suppurativa. They include:

• Antibiotic creams: Creams like Aczone (dapsone) or clindamycin to help treat infected lumps
• Resorcinol: A peel to unclog hair follicles and reduce inflammation
• Lidocaine: Often used in combination with an ice pack to control pain
  

Oral Medications

Oral medications might be used if topical medications aren't effective. Possible oral medications for hidradenitis suppurativa include:

• Antibiotics: Antibiotics in the tetracycline family seem to be particularly effective for HS. They help treat bacterial infections.
• Acitretin: A retinoid used for severe psoriasis that promotes healthy skin growth.
• Hormonal medications: Spironolactone (a diuretic used to treat conditions like high blood pressure) or birth control pills to reduce androgens. Androgens are sex hormones that can contribute to conditions like acne.
• Metformin: A diabetes drug that reduces inflammation in the body. Diabetes is a condition that involves abnormally high levels of sugar in the bloodstream due to a lack of the hormone insulin.
  
• Steroids: Drugs that reduce inflammation.
  
• Humira (adalimumab): A medication used to treat inflammatory conditions like rheumatoid arthritis, or RA (an autoimmune disease that attacks the joints) and plaque psoriasis (an autoimmune skin disorder that causes inflamed patches and silver-colored scales). Adalimumab stimulates the immune system and can reduce symptoms of HS.
• Cymbalta (duloxetine): A medication used to treat conditions like depression, generalized anxiety disorder (GAD), and chronic pain. It can help treat symptoms of depression associated with HS.
  

Adalimumab is the only medication approved by the FDA to treat HS. It's a biologic, meaning it's a complex medication made from living cells (e.g., plants or animals). Adalimumab is a strong medication that is not appropriate for everyone, including children under the age of 12.

In-Office Procedures

If left untreated, hidradenitis suppurativa can worsen, causing pus-filled tunnels under the skin called sinus tracts. At that point, your dermatologist may suggest one or more of the following procedures, which can be done in their office:

• Botox (botulinum toxin): The FDA has approved Botox to treat hyperhidrosis (excessive sweating). If sweating worsens your symptoms, Botox injections may indirectly improve your HS symptoms by reducing sweating.
• Corticosteroid injections: Corticosteroids can reduce inflammation when injected into early HS nodules, before they tunnel under the skin or become infected.
• Incision and drainage: Your dermatologist can drain a painful abscess that is filled with pus. This can relieve pain and pressure, but it's usually a short-term solution. Many abscesses return in the same spot.
• Laser hair removal: Removing some hair in the affected area can help reduce HS lumps. Your dermatologist may suggest multiple treatments to get it under control.
• Deroofing: Your dermatologist may consider a deroofing procedure if you have a lesion that returns in the same spot. They'll remove the top layer of skin, opening the wound so it can heal. This procedure reduces the risk of the lesion returning.
• Wide excision: A wide excision may be helpful if medication does not improve your symptoms. It's similar to deroofing, but it can remove the entire lesion, including the tunnel underneath the skin. The wound is longer but is also left open to heal on its own. Many dermatologists combine medication with excision when treating hidradenitis suppurativa.
  

Wound Care

Hidradenitis suppurativa can cause slow-healing wounds, so wound care is an important aspect of treatment. Your dermatologist can advise you on which type of wound care you need, depending on your symptoms. It may involve changing dressings regularly, soaking your wounds, or using antiseptic washes.

Lifestyle

You can reduce symptoms of hidradenitis suppurativa at home. Dermatologists often recommend the following:

• Avoid smoking: Some people with HS completely resolve their condition when they stop smoking. If you smoke, reach out to your healthcare provider for help quitting. 
• Take care of your skin: Some soaps, lotions, and other skincare products may cause skin irritation for people with HS. Your dermatologist may recommend washing your body with antimicrobial soap, like benzoyl peroxide, or finding products that are more gentle on your skin.
• Wear loose clothing: Tight clothing can rub on the skin and worsen the symptoms. Wear looser clothing for more comfort.
• Avoid sweating: Getting overheated and sweating can worsen HS. Try to exercise in an air-conditioned building and avoid going out during the hottest part of the day if possible.
• Try acupuncture: Acupuncture can help relieve pain caused by HS.

Laser Surgery

Laser surgery may be helpful for people with severe hidradenitis suppurative. Surgery can remove scar tissue and lumps under the skin, helping you to feel more comfortable. Surgery can only be used after HS has been controlled through other means. Recovery can take up to six months.

Living With and Managing Hidradenitis Suppurativa

Hidradenitis suppurativa is relatively common, affecting about 1 in 100 people. However, because it's relatively unknown, most people live with it for years before consulting with a healthcare provider. If left untreated, HS can worsen, causing pus-filled tunnels under the skin called sinus tracts. More severe HS can affect your quality of life.

Living with HS can be frustrating and isolating. You may feel embarrassed and try to hide your condition. People with advanced HS live with chronic pain, which can contribute to symptoms of depression. Lesions can become inflamed and leak foul-smelling fluid, which can add to emotional stress.

Hidradenitis suppurativa can be managed well and you may be able to live a pain-free life, but treating the condition as early as possible is key. You may need to try several different treatments before finding one that works for you.

A Quick Review

Hidradenitis suppurativa can be a challenging condition to manage. However, many different types of treatment can relieve symptoms, including medications, procedures, and lifestyle changes. Treatment aims to reduce pain, heal HS wounds, reduce flare-ups, and prevent the condition from worsening.

Reach out to your healthcare provider or a dermatologist to get treatment if notice potential symptoms and contact a mental health professional if you experience symptoms of depression. Many forms of support are available.