There is no cure for hidradenitis suppurativa. But early and long-term treatment may help control pain, promote wound healing, keep new lumps from forming and prevent complications.
Several treatment options are available. Talk with your doctor about the risks and benefits of each and which combination of self-care, drugs or surgical procedures are right for you.
Your doctor might prescribe one or more of the following types of medications:
- Topical and oral drugs. These include antibiotics and drugs derived from vitamin A (retinoids).
- Other drugs that reduce inflammation. Injecting steroid medications directly into the tender nodule can reduce inflammation. Oral steroids, such as prednisone, can also help. But long-term use of prednisone has many side effects, including bone thinning (osteoporosis).
- Hormones. Small studies comparing oral antibiotics with hormonal therapy showed the hormonal therapy to be as effective as antibiotics in treating sores of hidradenitis suppurativa. Further study is needed. Hormonal therapy is not suitable for pregnant women due to the risk of side effects.
- Drugs that suppress the immune system. The drugs infliximab (Remicade) and adalimumab (Humira) show promise in the treatment of hidradenitis suppurativa. These "biologics" are TNF inhibitors. They work by neutralizing an immune system protein known as tumor necrosis factor (TNF). Researchers continue to assess these and similar drugs. Possible side effects include an increased risk of infection, heart failure and certain types of cancers.
- Pain medication. If over-the-counter pain relievers don't help, your doctor may prescribe a stronger type. Examples include a fentanyl patch, codeine, morphine, gabapentin and pregabalin.
Surgery and other procedures
Hidradenitis suppurativa may be treated with various surgical approaches. The method used depends on the extent and location of the wounds, among other factors.
- Uncovering the tunnels. Known as unroofing, this procedure is gaining favor over incision and drainage. Your doctor cuts away the skin and flesh that cover any interconnected tunnels. This solution usually doesn't have to be repeated.
- Punch debridement. This procedure is also called mini-unroofing and may be used to remove a single inflamed nodule.
- Incision and drainage. Surgical drainage may be an option when the disease involves a single small area. This treatment generally provides short-term pain relief, but the sores tend to recur.
- Tissue-sparing excision with electrosurgery. This may be an option for people with severe hidradenitis suppurativa. It combines skin-tissue-sparing excision with electrosurgical peeling (STEEP). The goal is to remove diseased tissue and preserve healthy tissue. You will be given general anesthesia for the STEEP procedure.
- Surgical removal. Surgical treatment of recurrent or severe symptoms involves removal of all involved skin. A skin graft may be necessary to close the wound. Even after you have surgery, sores may still occur in other areas. In men whose condition involves the area between the anus and scrotum, surgical removal of the scrotum is almost always necessary.
Zinc supplements taken daily may help reduce inflammation and prevent new outbreaks.