Hidradenitis suppurativa treatments
Current treatment options
HS can be challenging to manage, but a lot of different treatment options are available, ranging from traditional medications and surgery to holistic approaches that involve nutrition and lifestyle changes. A combination of these options can significantly improve the quality of life for people living with HS. The range of treatment options is constantly evolving.
Although HS cannot be cured, the right treatment plan can help you manage painful or inconvenient symptoms and prevent new flare-ups. Flare-ups can lead to complications such as skin tunnelling and scarring, but early intervention may prevent them.
Your dermatologist and GP will work with you to create an individualised treatment plan to control your symptoms, reduce flare-ups and improve your quality of life. However, it’s important to ask questions to understand why a particular treatment is being recommended — and to speak up if it doesn’t feel like the right fit for you.
People with mild to moderate HS may require only topical or oral treatments, while those with severe symptoms also have effective options available.
Topical treatments
Topical treatments are applied to the skin’s surface and can be used at any stage of HS. Topical antibiotics, such as clindamycin, can reduce inflammation and treat abscesses.
Resorcinol cream, a peeling agent, can unblock hair follicles and help manage itching and other symptoms during flares. It also has antiseptic and anti-inflammatory properties.
Oral medications
Oral (taken by mouth) antibiotics such as doxycycline or minocycline are also prescribed. Sometimes, oral hormonal therapies like birth control pills or spironolactone can help manage the condition in women. Retinoids (topical and oral) are commonly used for acne and may be considered for people with acne-like HS.
Biologic medications
For people with moderate to severe HS, biologic medications (biologics) may be recommended. Biologics have been used for decades to treat other chronic conditions, such as inflammatory bowel disease (IBD) and spondyloarthritis. Biologics work by calming the immune system, reducing inflammation and preventing damage caused by HS.
Because biologics contain large proteins, they cannot be taken orally. Therefore, they need to be injected under the skin or infused into a vein. Injections can often be done at home, while intravenous infusions (IVs) are given at a doctor’s office or clinic.
In Australia, dermatologists can prescribe the biologics adalimumab, secukinumab and bimekizumab for your HS if you meet the strict criteria. Each works on the immune system in a different way, so you may need to try more than one to find the biologic that works best for you.
While you are taking biologics, you can’t receive live vaccines. However, you can receive non-live vaccines. Always talk to your GP about the vaccine options available to you.
Your doctors may also recommend combining a biologic with other treatments, such as surgery or additional medications, to better control symptoms and improve your quality of life. If your current treatment isn’t working, ask your dermatologist if biologics might be right for you.
Other treatments may help alleviate your HS, depending on its severity. Some treatments can be expensive, and healing can take time.
Talk to your treating doctor to discuss which option is best for you.
Surgical options
- Deroofing: The top layer of skin is removed to expose and treat tunnels (sinus tracts) beneath the surface. This process also involves removing abscesses and opening the tunnels to promote healing.
- Excisions: Single abscesses or small areas of HS can be removed by completely cutting them out (local excision). This approach works best for early hidradenitis suppurativa (HS) but may not prevent new abscesses from forming. Wide excisions also remove a margin of healthy skin tissue around abscesses, while radical excisions involve removing a more extensive area of skin tissue.
- Incision and drainage (I&D): An incision is made into the affected area to drain pus and reduce pressure from an abscess. I&D has a high recurrence rate.
- Laser therapy: Uses lasers to remove diseased skin and provide longer-lasting relief.
- Reconstructive options: After surgery, wounds may heal naturally, be closed with stitches or be covered with a skin graft (a piece of healthy skin).
In-clinic options
- Intralesional corticosteroid (ILCS) therapy: These localised corticosteroid injections reduce swelling and help prevent early abscesses from worsening.
- Laser hair removal: This procedure targets and removes hair follicles in affected areas, potentially reducing the risk of new abscesses.
Researchers are actively exploring new treatment options for moderate-to-severe HS, with promising results in targeting specific cytokines such as IL-17 and IL-1α. There are many clinical trials underway globally, offering hope for innovative treatments and a brighter future for those living with HS. These trials highlight the progress being made in understanding and managing this condition.
Ask your dermatologist or Hidradenitis Suppurativa Australia for information about relevant clinical trials.
Cagalj AM, et al. New and Emerging Targeted Therapies for Hidradenitis Suppurativa. International Journal of Molecular Sciences. April 2022. https://doi.org/10.3390/ijms23073753
Frew J, et al. Australasian hidradenitis suppurativa management guidelines. Australasian Journal of Dermatology. November 2024. https://doi.org/10.1111/ajd.14388
Vekic D, et al. Hidradenitis suppurativa – Management, comorbidities and monitoring. Australian Family Physician. https://www.racgp.org.au/afp/2017/august/hidradenitis-suppurativa-management-comorbidities
