The mainstays of conventional treatment for HS include antibiotics and surgery. Other medications, lasers, peels and injections are also commonly used.
In conventional medicine, the first treatment offered to people with HS is usually antibiotic therapy. Your doctor may recommend starting with a topical antibiotic such as clindamycin or dapsone. For people who don’t respond to the topical antibiotics, doctors often recommend a mix of oral antibiotics.
While some people respond well to antibiotic therapy, it’s important to understand the side effects. Because antibiotics kill off the beneficial bacteria that naturally live in our gut, they can cause major imbalances in the entire body. For example, long-term antibiotic use can cause chronic vaginal yeast infections, diarrhea, abdominal pain, skin rashes, and liver problems. Some people also experience headaches, dizziness, joint pain and more.
Other medications that are commonly used for HS include hormone therapies (such as spironolactone and certain birth control pills), blood sugar-lowering medications (such as metformin), immune-suppressing drugs (like Humira®), and over-the-counter painkillers.
Surgery and Lasers
In some cases, a boil can be so painful and inflamed that it needs to be pierced open in order to release the fluid inside. This procedure is called lancing and many people with HS have it performed at the doctor’s office or hospital.
There is another procedure called deroofing, where the ‘roof’ of an abscess, cyst or sinus tract is surgically removed. Next, a cross-shaped incision (cut) is made over the abscess to open it. The pus and dead tissue are removed, and then the cavity is filled with antiseptic-soaked packs. Deroofing is ideal for people with mild to moderate HS lesions, and it can be easily performed in a doctor’s office. Overall, people report high satisfaction with this technique, and it can be very effective in the long-term.
Lasers and intense pulsed light (IPL) are also useful for HS. Carbon dioxide lasers can be used for cutting or vaporizing the affected area, and this is typically done under local anesthesia. Because HS lesions start with clogging of the hair follicles, lasers and IPL that target the hair can be especially effective. Many people report great improvements in their HS symptoms after laser hair removal.
The most extreme type of surgery for HS is called wide excision, and it’s usually reserved for very severe cases. In this type of surgery, the entire area of affected skin is cut out and removed from the body. After the skin is removed, the area is stitched closed or covered with a skin graft. If you’re considering wide excision surgery, it’s important to understand that it’s not a guaranteed cure. While many people achieve permanent results with surgery, it’s also very common for the lesions to come back. We’ve encountered several people with HS who’ve had surgery in one area, only to have the lesions come back in the exact same spot or a different place altogether.
Chemical peels like resorcinol, glycolic acid, malic acid, and mandelic acid can be a great treatment option. Many peels are available over-the-counter. Peeling agents work for HS by breaking down the keratin (skin) proteins that promote clogging and nodule formation. When a nodule is inflamed, the peel will cause the lesion to either burst open quickly or shrink and dissolve. Most people who use peels notice very fast pain relief, a shorter duration of flares and fewer breakouts overall. One of the best things about peels is that they’re easy to apply on your own and they can be used for daily maintenance. However, we always recommend consulting with a dermatologist or licensed skin care professional who can guide you on selecting the right peel for you and how to use it. Peels and acids should not be used on open wounds.
Triamcinolone acetonide is a steroid that can be injected into HS lesions. This therapy is also known as “intralesional Kenalog” or “ILK injections,” and it’s quite common. It’s a relatively quick and safe treatment option, but it’s not curative. The injection helps HS by reducing pain and inflammation, and also by shrinking abscesses and sinus tracts. The relief typically lasts for about two weeks, but the effects are cumulative and get better with each treatment. Many doctors recommend getting the injections every two weeks for maximal benefit.
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Dr. Ashley Biscoe
Dr. Alison Egeland
About Ashley and Alison
We are naturopathic doctors who are on a mission to provide trustworthy information and tools for the millions of people worldwide who suffer from hidradenitis suppurativa. After scouring the medical research and working with patients who have HS, we’ve developed a deep understanding of this condition and how devastating and painful it is. We created this site to share what we’ve learned (and continue to learn) so that we can help as many people as possible.