Treating hidradenitis suppurativa with antibiotics and hormones
Understand how these therapies can improve your condition at different stages.
If you have the chronic skin condition hidradenitis suppurativa, your dermatologist will recommend treatment options to help heal your existing lesions and prevent new ones from forming. Antibiotic and hormone therapy can be effective components of your treatment, regardless of the stage of your condition. Here's help understanding when these treatments might help, how they work and the possible side effects.
These drugs treat any infection in your lesions, as well as unpleasant odors infections can cause. Antibiotics can also lessen inflammation, heal lesions and prevent new lesions from forming.
Antibiotics can be applied to your skin topically or taken by mouth. If your hidradenitis suppurativa is mild, your doctor might first recommend topical antibiotics, such as clindamycin. Applying the topical antibiotic twice daily might be enough to manage your lesions, though treatment duration varies.
Oral antibiotic therapy is usually recommended for moderate to severe hidradenitis suppurativa or milder cases that don't respond to lifestyle changes or topical antibiotics. A seven- to 10-day course of antibiotics might help soothe inflammation.
Oral antibiotics frequently prescribed to treat hidradenitis suppurativa include doxycycline monohydrate (Monodox, Adoxa, others), minocycline, tetracycline, clindamycin (Cleocin), erythromycin, rifampin (Rifadin) and amoxicillin/clavulanate (Augmentin, Augmentin ES-600). You might need antibiotic therapy for a few weeks or long-term to manage your condition.
Before recommending an antibiotic, your doctor will consider any allergies you might have, other medications you're taking and your history of success with the medication.
While rare, possible side effects include:
- Clostridium difficile bacterial infection
- An orange discoloration of bodily fluids
- Minor burning sensation from topical antibiotics
If you're pregnant, talk to your doctor about which antibiotics might be safe for you.
Because hormones called androgens are thought to trigger hidradenitis suppurativa, hormone therapy can be useful in controlling the condition. The most commonly prescribed hormones include oral contraceptives containing the hormones estrogen and norgestrel and an oral contraceptive that contains the hormone drospirenone, finasteride (Propecia, Proscar) and dutasteride (Avodart).
Possible side effects of hormone therapy in women include:
- Birth defects if taken during pregnancy
- Blood clots
Possible side effects of finasteride in men include:
- Decreased sex drive (libido)
- Problems with ejaculation
- Tender breasts
- Breast tumors
Your doctor might recommend combining antibiotic and hormone therapies — in addition to making lifestyle changes, such as quitting smoking and managing your weight — for greater effectiveness. Before trying a new treatment, be sure to ask your doctor questions about the risks and benefits.
See more In-depth
- Dahl MV, et al. Hidradenitis suppurativa (acne inversa): Treatment. http://www.uptodate.com/home. Accessed Feb. 1, 2017.
- Ingram JR, et al. Interventions for hidradenitis suppurativa (review). Cochrane Database of Systematic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010081.pub2/full. Accessed Feb. 1, 2017.
- Finasteride. Micromedex 2.0 Healthcare Series. http://www.micromedexsolutions.com. Accessed Feb. 17, 2017.
- Gibson LE (expert opinion). Mayo Clinic, Rochester, Minn. March 7, 2017.