How To Treat Hidradenitis Suppurativa? What You Need to Do

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes painful lumps under the skin, most often in the armpits, groin, and buttocks. There is no permanent cure, but treatment can reduce flares, control pain, and limit scarring. The right approach depends on how severe your disease is, and it usually combines medical treatment, skin care, and sometimes procedures or surgery.

If you think you have HS, the most important first step is getting an accurate diagnosis from a dermatologist. HS is frequently mistaken for boils, acne, or an infection, and that delay can let the disease progress. Treatment works best when it starts early.

What Is Hidradenitis Suppurativa and Why Does It Happen?

HS is a disease of the hair follicles, not a hygiene problem and not contagious. It develops when follicles in certain skin folds become blocked and inflamed, then rupture. The result is deep, tender nodules that can drain pus, form tunnels under the skin, and leave scars.

The exact cause is not fully understood, but several factors are well established. The condition involves an abnormal immune response around the hair follicle. Genetics play a role — about one in three people with HS report a family history. Smoking and obesity are strongly associated with the disease, though they are not the sole cause. Hormones appear to influence it too, since HS often begins after puberty and can change during pregnancy or menopause.

HS is not caused by poor hygiene. Many people with the condition are told otherwise, and that misinformation adds real harm. It is also not a sexually transmitted infection.

The condition tends to run a relapsing course. Periods of flares alternate with periods of calm. Over time, without treatment, the inflammation can create permanent tunnels and scarring in the affected areas.

How To Treat Hidradenitis Suppurativa: The Main Options

Treatment is staged. What works for mild, occasional lumps is different from what works for widespread, draining disease. A dermatologist will usually assess severity using a system that counts how many inflamed lesions you have and how much they affect your daily life.

For mild disease

Topical treatments may be used for early, limited HS. These can include antibiotic creams or washes. Some clinicians also recommend topical resorcinol, a compound that has shown benefit in smaller studies for reducing pain and lesion size. The evidence for topical options is more limited than for systemic treatment, and results vary between people.

For moderate to severe disease

Systemic treatment means medicine that works throughout the body. The main categories are:

• Antibiotics taken by mouth, often for weeks to months. These are used for their anti-inflammatory effects as much as for killing bacteria. Tetracyclines such as doxycycline are common first choices. A combination of clindamycin and rifampin is also used.
• Hormonal therapy in some women, since androgens appear to play a role. Options include certain combined oral contraceptives and spironolactone. Response varies, and not everyone benefits.
• Biologic medications that target specific parts of the immune system. Adalimumab was the first biologic approved for moderate to severe HS. Other biologics are used as well. These are generally reserved for disease that has not responded to other treatment.
• Retinoids such as acitretin, which some clinicians prescribe. The evidence for these is weaker than for biologics.

Treatment trials take time. Antibiotics and hormonal treatments are often given for several months before a decision is made about whether they are working. Biologics also require a trial period. This is frustrating for people in pain, but stopping too early can mean abandoning a treatment that would have helped.

One point worth stating plainly: no single treatment works for everyone with HS. Response is individual, and finding an effective plan often involves trying more than one option.

When Procedures and Surgery Help

Medical treatment controls inflammation. Procedures address the physical damage the disease has already caused.

For individual painful nodules, a doctor may inject a corticosteroid directly into the lesion. This can reduce pain and size within days. It is a short-term measure, not a long-term solution.

When nodules come to a head or become very painful, incision and drainage can relieve pressure. It is important to understand its limits: drainage does not treat the underlying disease, and the same area often flares again.

For tunnels, scars, and areas of repeated flares, surgery can remove the affected tissue entirely. This is the only approach that can eliminate the disease in a specific area. Techniques range from localized excision to wider removal, sometimes with skin grafting. Recurrence is possible, especially if surgery is done in an area where disease is still active elsewhere.

Laser therapy and other energy-based treatments are also used in some centers. Evidence for these is growing but not as strong as for surgery or biologics. They are not universally available, and insurance coverage varies.

What You Can Do Day to Day

Self-care does not replace medical treatment, but it can reduce irritation and support whatever treatment you are on.

• Avoid tight clothing in the affected areas. Friction and pressure can trigger flares.
• Wash gently with a mild cleanser. Do not scrub or use harsh exfoliants.
• Do not squeeze, pop, or cut open lumps. This can push inflammation deeper and worsen scarring.
• Keep the skin dry. Moisture in skin folds can aggravate the condition.
• Warm compresses may ease pain from individual lesions.
• If you smoke, quitting is one of the most useful steps. Smoking is strongly linked to worse HS, and stopping may improve symptoms for some people.

Weight loss is often discussed in HS care. The relationship is real but not simple. Excess weight is associated with more severe disease, and some people see improvement with weight loss. But HS is not caused by weight alone, and people of any body size can have it. Weight loss is not a guaranteed fix, and it should never be presented as the only answer.

Pain management matters and is often overlooked. HS pain is real and can be significant. Talk to your doctor about it rather than enduring it silently. Mental health support is also worth considering, since the condition can affect self-image, relationships, and daily functioning.

Why Early Treatment Matters

HS is progressive in many people. Inflammation that is not controlled can lead to permanent tunnels and scars. Once those form, they do not reverse with medication — only surgery can remove them.

This is why seeing a dermatologist early matters. A delay of months or years can mean more damage to treat later. If you have recurring, painful lumps in the same areas, especially in the armpits, groin, or under the breasts, it is worth getting evaluated rather than assuming they are ordinary boils.

Getting the right diagnosis also prevents unnecessary treatment. HS is sometimes treated with repeated courses of antibiotics for what is assumed to be a simple infection. That approach does not address the underlying disease and can delay effective care.

What the Evidence Does and Does Not Show

Some parts of HS care rest on strong evidence. Biologic therapy for moderate to severe disease has been studied in randomized controlled trials, and adalimumab is approved for this use. Surgery reliably removes disease in the treated area. Smoking is consistently associated with worse outcomes.

Other parts are less certain. Dietary changes are frequently discussed online, and some people report improvement with elimination diets. There is no large, high-quality trial confirming that any specific diet treats HS. If you want to try dietary changes, discuss them with your doctor and a dietitian rather than relying on anecdotal claims.

Similarly, many supplements marketed for HS have no clinical evidence behind them. Be cautious of any product that claims to cure or reverse the condition.

Frequently Asked Questions