Hidradenitis Suppurativa Treatment

Smoking cessation is an important part of hidradenitis suppurativa treatment. Smoking is strongly associated with HS and may contribute to ongoing inflammation, recurrent flares, and more difficult-to-control disease. Quitting smoking can be an important step in reducing inflammatory burden and improving overall long-term disease control. At Peak Skin Center, we view smoking cessation as part of a comprehensive hidradenitis suppurativa treatment plan, alongside medical and surgical therapy.

Topical therapy is often an important part of hidradenitis suppurativa treatment, especially in earlier-stage disease, in patients with recurrent inflamed bumps, and as part of a broader long-term maintenance plan. These treatments are designed to reduce inflammation, decrease bacterial burden on the skin, limit follicular plugging, and help calm active lesions.

Topical Antibiotics

Topical antibiotics, most commonly clindamycin, are often used for hidradenitis suppurativa involving recurrent inflammatory papules, pustules, and smaller nodules. These medications help reduce bacterial overgrowth on the skin and also provide anti-inflammatory benefit. In appropriate patients, topical antibiotic therapy can help decrease tenderness, drainage, and the frequency of flares.

Antiseptic Washes and Antimicrobial Cleansers

Antiseptic cleansers such as chlorhexidine, benzoyl peroxide washes, and other antimicrobial skin cleansers are commonly used to reduce surface bacteria and support a cleaner skin environment in areas prone to recurrent inflammation. These are often used as part of a daily skin care routine and may be combined with prescription medications for a more comprehensive approach.

Keratolytic and Follicular-Targeting Topicals

Some topical treatments are used to reduce follicular plugging and help normalize the way skin cells shed within the hair follicle. Agents in this category may include retinoid-based topicals or other medications that help decrease clogging of the follicular unit. Because hidradenitis suppurativa begins with inflammation centered around the follicle, reducing follicular obstruction can be an important part of treatment in selected patients.

For patients with more persistent or widespread hidradenitis suppurativa, oral medications are often an important next step. Oral therapy can reduce inflammation from the inside, lower flare frequency, and help gain control over disease that is too active for topicals alone.

Oral Antibiotics

Oral antibiotics are commonly used in hidradenitis suppurativa not only for antimicrobial effect, but also for their anti-inflammatory properties. Tetracycline-class antibiotics, including doxycycline and minocycline, are frequently used as first-line oral options. In more stubborn cases, combination antibiotic regimens such as clindamycin and rifampin may be considered. These medications are often used to reduce pain, swelling, drainage, and the frequency of recurrent flares.

Hormonal Therapy

Hormonal therapy can play an important role in selected patients, especially when hidradenitis suppurativa appears to flare with menstrual cycles or when there are signs of androgen influence. Medications such as spironolactone or certain hormonal contraceptives may help reduce flare activity by decreasing hormonal stimulation of the follicular unit and inflammatory pathways.

Oral Retinoids

Oral retinoids may be considered in carefully selected patients, particularly when follicular occlusion is a major driver of disease or when hidradenitis overlaps with acneiform skin conditions. These medications work by helping normalize keratinization and decreasing follicular plugging. They are not right for every patient, but they can be useful in the right clinical setting.

Biologic therapy has become an important treatment option for patients with moderate to severe hidradenitis suppurativa. These medications are designed to target key inflammatory signals that drive the disease process.

TNF-Alpha Inhibitors

Adalimumab is a biologic therapy used in hidradenitis suppurativa that works by blocking tumor necrosis factor alpha (TNF-alpha), a major inflammatory messenger involved in chronic skin inflammation. By reducing TNF-alpha signaling, adalimumab can help decrease the number of inflamed nodules and abscesses, improve pain, and reduce overall flare burden.

IL-17 Pathway Inhibitors

The IL-17 pathway is another major inflammatory pathway involved in hidradenitis suppurativa. Biologics in this category like secukinumab and bimekizumab work by blocking IL-17 signaling, which helps calm the immune activity that contributes to painful nodules, abscesses, and tunnels. These treatments can be an important option for patients whose disease is more extensive, more inflammatory, or not adequately controlled with other therapies.

Surgical treatment is often an essential part of hidradenitis suppurativa care, especially when there are persistent nodules, recurrent abscesses, draining sinus tracts, or scarred areas that are unlikely to improve with medication alone.

Incision and Drainage

When a lesion becomes acutely painful, swollen, and fluctuant, incision and drainage may provide short-term relief by releasing built-up fluid and pressure. This can be helpful for symptom relief, although it does not treat the underlying disease process and is not usually considered a definitive long-term solution.

Deroofing

Deroofing is a targeted surgical technique used to open chronic tunnels and remove overlying tissue while preserving as much healthy surrounding skin as possible. This approach can be especially helpful for recurrent sinus tracts and chronically draining areas. It is often well suited for patients with localized but persistent disease.
Excision