Hidradenitis Suppurativa (HS) Medication Options

Hidradenitis suppurativa (HS) is a chronic (long-term) condition that causes painful lesions under the skin.

Many people take years to receive a proper HS diagnosis because it can look like pimples or acne. Without appropriate treatment, HS can worsen and lead to complications, including abscesses (infected, pus-filled lumps), intense pain, and sinus tracts (pus-filled tunnels under the skin).

In severe cases, HS can make it difficult to complete daily activities such as sitting, walking, or reaching for things. HS can’t be cured, but treatment options can reduce symptoms and complications. These include medications, such as biologics, antibiotics, corticosteroids, hormonal therapy, retinoids, and pain control.

Biologics are drugs made from living organisms, such as plant or animal cells, that have been engineered to produce a specific protein. Most biologics target a specific part of your immune system and change its function. They treat a range of medical conditions, including moderate to severe HS.

Biologics help reduce inflammation in HS. Biologics for HS include Humira and Cosentyx.

Humira (Adalimumab)

Humira is an injectable medication approved by the United States Food and Drug Administration (FDA) for people 12 or older with moderate to severe HS. In studies, people who took Humira had fewer abscesses and lesions than people who took a placebo.

You can inject Humira yourself at home. The recommended initial dosage for adults or children weighing 88 pounds or more is 160 milligrams on the first day. After two weeks, you’ll take an 80-milligram dose, and starting on day 29, you’ll continue with 40 milligrams every other week. The dosage for children under 88 pounds depends on their body weight.

While Humira is an effective treatment option for moderate to severe HS, it isn’t right for everyone. Some of its side effects include headache, rash, an increased risk of infections, and reactions at the injection site.

Cosentyx (Secukinumab)

Cosentyx is another FDA-approved at-home injection for moderate to severe HS in adults. The recommended dosage is 300 milligrams once weekly for the first five weeks, then 300 milligrams once every four weeks.

Common side effects of Cosentyx include the common cold, diarrhea, and upper respiratory tract infections.

Other Biologic Options

Other biologics used to treat HS include Remicade (infliximab), Kineret (anakinra), Stelara (ustekinumab), Enbrel (etanercept), Simponi (golimumab), and Bimzelx (bimekizumab-bkzx). Evidence for the use of these drugs isn’t as strong as it is for Humira or Cosentyx. More research is needed to understand their effectiveness for HS and the appropriate dosage.

Healthcare providers may prescribe oral (taken by mouth) and topical (applied to the skin) antibiotics to treat and prevent inflammation and bacteria that cause HS lesions.

Topical Antibiotics

Topical antibiotics, such as Cleocin (clindamycin), are effective for mild cases of HS. This medication reduces lesions and pus-filled lumps and can help treat an infection. It’s generally applied twice daily, but your healthcare provider will prescribe the best dosage for you.

While Cleocin was well-tolerated in studies, there is a risk of antibiotic resistance in people who use it long-term. The bacteria in your body can develop defenses against the drug, which makes it more difficult for the drug to clear the infection.

Oral Antibiotics

Oral antibiotics are generally prescribed for moderate HS symptoms or when topical antibiotics are ineffective. While antibiotics are typically used to clear bacteria, they’re more useful in HS for their effects on the immune system.

Commonly used oral antibiotics for HS include:

• Tetracycline antibiotics, such as doxycycline
• Rifadin, Rimactane (rifampin)
• Cleocin (clindamycin)
• Avelox (moxifloxacin)
• Flagyl (metronidazole)
• Aczone (dapsone)
• Invanz (ertapenem)

Dosage and potential side effects vary depending on the antibiotic prescribed. The typical dosage of doxycycline is 100 milligrams twice daily, whereas moxifloxacin is 400 milligrams taken once daily. Healthcare providers may prescribe oral antibiotics alone or in combination with topical treatments.

Healthcare providers may prescribe corticosteroid injections or pills to reduce inflammation and manage pain.

Corticosteroid injections may be helpful for early, painful lesions that aren’t infected. The medication is injected directly into an HS nodule to help decrease swelling and pain. However, they are not effective for treating tunnels under the skin.

Alongside your existing HS treatment, your healthcare may consider prescribing low-dose oral corticosteroids to help reduce flare-ups in severe cases.

While oral corticosteroids can work quickly to treat HS, they usually aren’t prescribed long-term due to potential side effects, such as high blood sugar (hyperglycemia), sleep disturbances (insomnia), and mild restlessness.

Androgens are a type of hormone known to influence HS. Because of this, hormone medications may be useful in treating HS, especially if you experience flare-ups around your period or while pregnant.

Hormone therapy can help decrease inflammation and pain caused by HS. Examples of hormone medications used for HS include:

• Aldactone (spironolactone)
• Proscar (finasteride)
• Metformin (glucophage)
• Birth control pills that contain estrogen

A healthcare provider may prescribe hormone therapy alone in mild to moderate HS. In severe cases, your healthcare provider may prescribe them alongside other HS treatments. The dosage will depend on the medication prescribed. A mild upset stomach could occur while taking metformin.

While they aren’t an initial go-to treatment option, retinoids are occasionally used for HS. Retinoids support skin health and help with skin concerns like acne. Healthcare providers may only recommend retinoids if you have both HS and acne.

Soriatane (acitretin) and Claravis (isotretinoin) are the most commonly used retinoids for HS. Isotretinoin also goes by the brand names Amnesteem, Myorisan, and Zenatane.

One risk when using retinoids is severe harm to an unborn baby if taken during pregnancy. For those who can become pregnant, your healthcare provider will likely require two pregnancy tests before you start treatment and monthly pregnancy tests during treatment.

Retinoids may also cause various side effects, such as slow-healing wounds, dry skin, hair loss, and skin peeling.

Pain relief is an important part of HS treatment. One of the main symptoms of HS is painful lesions. Scarring, abscesses, open cuts, friction, or other sources can also cause HS-related pain.

Several medications can help relieve HS-related pain. These include:

• Topical lidocaine
• Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen)
• Tylenol (acetaminophen)
• Anticonvulsants, such as Neurontin (gabapentin) or Lyrica (pregabalin)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), including Cymbalta (duloxetine)

As with all drugs, pain relievers can cause side effects. The specific side effects depend on the medication prescribed. NSAIDs can cause stomach, heart, and kidney problems, whereas Tylenol (acetaminophen) can cause serious liver problems.

There are other treatment options available for HS aside from medications, including:

• Skin care regimen
• Laser hair removal
• Botox (botulinum toxin)
• Surgical procedures
• Wound care
• At-home remedies, including warm water or black tea compresses
• Lifestyle changes, such as avoiding or quitting smoking

Healthcare providers often recommend a combination of treatments. This can depend on the type of lesions you have, whether pain or an infection is present, and if the condition affects your quality of life.

If you have symptoms of HS, such as painful or pus-filled lesions in areas where your skin rubs together, it’s best to consult a healthcare provider. HS can often look like other skin conditions, such as herpes or acne, and your provider can make an official diagnosis and recommend a treatment plan.

If you’re currently receiving HS treatment but feel your symptoms aren’t improving or are worsening, or you experience new or worsening side effects from your treatment, contact your healthcare provider. They can help determine whether you need an alternative, stronger, or additional treatment to manage your condition.

You should also seek care from a healthcare provider if you have any of the following:

• Severe pain
• Difficulty completing simple daily activities
• Changes in your mood, thoughts, or behavior
• Signs or symptoms of an infection, such as fever, severe redness, or pus

In some cases, HS can increase the risk of squamous cell carcinoma (SCC), a type of skin cancer. See your healthcare provider if you have a spot on your skin that is growing, bleeding, or changing.

Hidradenitis suppurativa cannot be cured, but treatment can help heal outbreaks, prevent flare-ups, and reduce the risk of complications. Medications such as biologics, antibiotics, corticosteroids, and hormone therapies can help reduce symptoms.

Some people require a combination of medications to manage their HS. A healthcare provider can recommend the best medication based on condition severity, medical history, and other medications.

Tell your healthcare provider about any side effects or worsening symptoms.