Treating hidradenitis suppurativa: Explore your options

When choosing a treatment for your hidradenitis suppurativa, you have several options. Get the facts about how they work.

While there's no cure for your hidradenitis suppurativa, treatment is essential to managing this chronic condition characterized by painful lumps under the skin.

To help you choose the most effective treatment, your doctor will ask about your medical history and determine the stage or severity of your hidradenitis suppurativa. Stage I involves single or multiple abscesses without tunneling wounds. Stage II involves recurrent abscesses with tunneling wounds and scarring, and stage III is marked by multiple interconnected tunneling wounds and abscesses. Share with your doctor how long you've had hidradenitis suppurativa, any previous treatments you've had that weren't successful and your treatment preferences.

Lifestyle changes and topical treatments are typically the first step, followed by medications that treat your entire body (systemic treatment). In severe cases, you might need surgery. The more advanced your hidradenitis suppurativa, the more intensive treatment you might need. Consider these treatment options and how they might help.

Lifestyle changes

Quitting smoking, managing your stress, losing weight and eating a nutritious diet can help you manage your hidradenitis suppurativa. Wearing loosely fitting clothing can also reduce skin irritation.

To keep skin clean and prevent secondary infection, follow a regular skin care regimen. Gently wash your body with a nonsoap cleanser such as Cetaphil. Acne treatments might help. A five- to 10-minute soak in a diluted bleach bath also can help kill bacteria on your skin.

Medications

Your doctor might recommend topical antibiotics, such as clindamycin (Cleocin T, Clindagel, others). You might also need oral antibiotics. These drugs can treat infections, minimize inflammation and prevent new lesions.

Corticosteroids, which are cortisone-like medications, can be taken orally or injected directly into your lesions to reduce inflammation.

Biologics are injectable drugs that block the immune system's inflammatory response. Adalimumab (Humira) is the only biologic drug approved by the U.S. Food and Drug Administration to treat hidradenitis suppurativa. This drug is effective against moderate to severe forms of the condition.

Oral retinoids, derived from vitamin A, regulate the growth of skin cells to help manage hidradenitis suppurativa. Acitretin and isotretinoin (Amnesteem, Claravis, others) are the oral retinoids used most commonly to treat hidradenitis suppurativa. Don't take oral retinoids during pregnancy. These medications can cause birth defects.

Small studies also have found that oral zinc supplementation might reduce and prevent hidradenitis suppurativa lesions. However, zinc gluconate might cause upset stomach.

Surgery

If your hidradenitis suppurativa is severe, your doctor might recommend one of several types of surgical treatment. Your surgeon might cut open and drain your lesions and any tunnels beneath your skin. Large, deep lesions can be cut out (excised) from your skin. These surgeries, however, can create large scars. In some cases, your surgeon might use a CO2 (carbon dioxide) laser to remove deep skin lesions and the hair follicle.

As you seek relief from your hidradenitis suppurativa, you might need to try a few different treatments. Often, a combination of treatments is most successful. Work with your doctor to customize your treatment plan.

April 11, 2017 See more In-depth