Hidradenitis suppurativa is a chronic skin disease marked by painful lumps, abscesses, and scarring in areas where skin rubs together. While there is no cure, a combination of medical treatments and surgical approaches can help control symptoms, reduce flare-ups, and improve quality of life for those living with this challenging condition.

Understanding Your Treatment Options for Hidradenitis Suppurativa

When you’re diagnosed with hidradenitis suppurativa (HS), also known as acne inversa, the main goal of treatment is to manage symptoms and prevent the condition from getting worse. This skin disease causes painful, deep-seated lumps, abscesses that drain pus, and eventually scarring, primarily in areas where your skin folds—like the armpits, groin, under the breasts, and between the buttocks.^[1][2]

Treatment approaches for HS are highly individualized because the disease affects everyone differently. Some people experience only occasional breakouts in one area, while others deal with widespread, recurring lesions that never fully clear. The treatment plan your doctor recommends will depend on how severe your condition is, which areas of your body are affected, and how you’ve responded to previous therapies.^[8]

Medical societies have developed treatment guidelines that help doctors decide which therapies to use at different stages of the disease. These recommendations are based on a classification system that groups HS into stages—from mild cases with just a few lumps in one area, to severe cases with multiple interconnected abscesses, tunnels under the skin, and extensive scarring.^[2][5]

Beyond the standard treatments that doctors have used for years, researchers are actively testing new medications and therapies in clinical trials. These studies offer hope for better options, especially for people whose symptoms haven’t improved with current treatments. Understanding both the established therapies and emerging treatments can help you work with your healthcare team to find the approach that works best for you.

Standard Medical Treatments for Hidradenitis Suppurativa

The cornerstone of HS treatment involves medications that reduce inflammation and fight bacterial infections. In the early stages of the disease, when you have just a few painful lumps, your doctor may start with medicines applied directly to your skin. These topical antibiotics, which come as liquids or gels, can help manage mild symptoms by reducing bacteria on the skin surface and preventing new breakouts.^[8]

For more widespread disease, oral antibiotics become necessary. Doctors commonly prescribe doxycycline (also sold as Monodox), clindamycin (Cleocin), or rifampin (Rimactane), sometimes using these medicines in combination. These antibiotics work not only against bacteria but also help reduce inflammation. Unlike the short courses of antibiotics you might take for a throat infection, HS often requires longer treatment periods—sometimes weeks or months—to bring symptoms under control.^[8][19]

When painful lumps or nodules develop, your doctor may inject them directly with corticosteroids, such as triamcinolone. These injections quickly reduce swelling and pain in individual lesions. For more severe flare-ups affecting multiple areas, your doctor might prescribe oral steroid pills for a short period, typically one to several weeks. While steroids are very effective at calming inflammation, they can cause side effects if used for extended periods, so they’re usually reserved for acute situations or as a bridge between different treatments.^[12][13]

Hormone-based treatments can help some patients, particularly women whose symptoms worsen before their menstrual periods. Medications like spironolactone or finasteride work by affecting hormone levels in the body, which can reduce the activity of oil glands and hair follicles. These treatments are often considered for patients who haven’t responded well to antibiotics alone.^[8][13]

One of the most significant advances in HS treatment came with the approval of biologic medications. Adalimumab (Humira) was the first biologic approved specifically for treating moderate to severe HS. Biologics are advanced medicines that target specific parts of the immune system involved in causing inflammation. Adalimumab blocks a protein called tumor necrosis factor (TNF), which plays a major role in inflammatory processes.^[8]

More recently, a new biologic called bimekizumab (marketed as Bimzelx) received approval from the US Food and Drug Administration. This medication represents a first-of-its-kind treatment because it targets not just one but two inflammatory proteins—interleukin-17A (IL-17A) and interleukin-17F (IL-17F). In clinical studies, around five in ten people taking bimekizumab saw a 50% reduction in the number of inflamed nodules and abscesses at 16 weeks, compared to about three in ten taking placebo. The medication is given as an injection every two weeks.^[13][14]

Pain management is a critical component of HS care. Doctors may recommend over-the-counter pain relievers for mild discomfort, or prescribe stronger medications for more severe pain. Some patients benefit from applying numbing creams like lidocaine to painful areas. Because HS can cause chronic pain that significantly affects daily activities, some people work with pain management specialists to develop comprehensive strategies, which might include complementary approaches like acupuncture or mind-body techniques.^[11][20]

Surgical and Procedural Treatments

When medications aren’t enough to control HS, various surgical procedures can help. The type of surgery recommended depends on how severe and widespread your disease is. For limited disease, a procedure called deroofing can be done in a doctor’s office while you’re awake. This involves removing the top layer of skin over tunnels that have formed under the skin, allowing them to heal from the bottom up and reducing the chance they’ll come back.^[12]

Sometimes doctors need to drain abscesses that are very painful or causing problems, though this provides only temporary relief. If you have recurring abscesses or deep nodules in one area, your doctor might recommend surgically removing just that affected tissue. For severe cases with extensive tunneling and scarring, wide surgical removal of all affected skin may be necessary, sometimes requiring skin grafts to close the wound.^[2][8]

Laser therapy has emerged as another treatment option. Different types of lasers can destroy hair follicles or reduce inflammation in affected areas. Some patients undergo laser hair removal treatments to reduce the number of hair follicles that might become blocked and inflamed. While laser treatments don’t work for everyone, they can help some people reduce the frequency and severity of flare-ups.^[2]

Duration and Side Effects of Standard Treatments

The length of treatment varies greatly depending on which approach you’re using. Topical treatments and oral antibiotics might be tried for several weeks to months before deciding if they’re working. Biologic medications often require at least 12 to 16 weeks before you can judge their effectiveness, and if they work, you may continue them long-term to keep symptoms under control.^[8]

All medications can cause side effects. Antibiotics may upset your stomach or increase your skin’s sensitivity to sunlight. Long-term antibiotic use can lead to antibiotic resistance or yeast infections. Biologics work by suppressing part of your immune system, which means they may increase your risk of infections. Before starting a biologic, your doctor will test you for tuberculosis and other infections, and you’ll need monitoring throughout treatment. Hormone treatments can cause side effects related to changing hormone levels, such as changes in menstrual periods or decreased sex drive.^[8][19]

Surgical procedures carry risks including infection, bleeding, delayed wound healing, and scarring. More extensive surgeries require longer recovery times and may result in significant scarring, though this is balanced against removing diseased tissue that was already causing pain and problems. Your surgeon will discuss these risks with you and help you understand what to expect during recovery.^[2]

Innovative Treatments Being Tested in Clinical Trials

Researchers around the world are studying new ways to treat HS, focusing on medications that target different parts of the immune system and inflammatory processes. These clinical trials offer access to cutting-edge treatments that aren’t yet available to the general public, and they help scientists understand which approaches work best for different patients.

Anti-Interleukin Therapies Under Investigation

One promising area of research involves medications that block various interleukins—proteins that serve as messengers in the immune system and contribute to inflammation. Scientists have found that certain interleukins are particularly active in HS lesions, making them attractive targets for new treatments.

An experimental drug called secukinumab blocks IL-17A, one of the same proteins targeted by the recently approved bimekizumab. Clinical trials have tested whether blocking just IL-17A alone can help HS patients. Another investigational medication called bermekimab takes a different approach by blocking interleukin-1 (IL-1), another inflammatory protein. Early results from these studies have been encouraging, showing that some patients experience improvement in their clinical parameters and symptom reduction.^[13]

These Phase II and Phase III clinical trials involve comparing the new medications against placebo or standard treatments to determine how effective they are and what side effects they might cause. Phase II trials focus on finding the right dose and gathering preliminary evidence of effectiveness in a smaller group of patients. Phase III trials involve larger numbers of participants and are designed to definitively prove whether a treatment works and is safe enough to deserve approval from regulatory authorities.

Understanding Clinical Trial Phases

Clinical trials follow a carefully designed sequence of phases. In Phase I trials, researchers test a new drug in a small group of healthy volunteers or patients to evaluate its safety, determine a safe dosage range, and identify side effects. These trials answer the basic question: Is this medication safe enough to test further?

Phase II trials involve larger groups of people who have the condition being studied. The primary goals are to gather more safety data and obtain preliminary evidence that the treatment works. Researchers carefully measure whether the medication improves specific symptoms or disease markers compared to placebo.

Phase III trials are large-scale studies involving hundreds or thousands of participants. These trials directly compare the new treatment against the current standard of care or placebo to definitively establish effectiveness and monitor side effects across diverse populations. Successful Phase III trials often lead to regulatory approval of new medications.

Eligibility and Locations for HS Clinical Trials

Clinical trials for HS are being conducted in multiple countries, including the United States, various European nations, and other regions worldwide. Each trial has specific eligibility criteria that determine who can participate. Common requirements include having a confirmed diagnosis of HS, disease of a certain severity level, and being within a specific age range. Trials often exclude people who have certain other medical conditions or who are taking medications that might interfere with the study.

Some trials specifically seek patients who haven’t responded well to standard treatments, while others may enroll people who are just starting treatment. Pregnant or breastfeeding women are typically excluded from trials testing new medications due to potential risks to the baby. Your doctor can help you determine whether you might be eligible for any ongoing clinical trials and can assist with the enrollment process if you’re interested.^[3]

Mechanisms of Action in Experimental Treatments

The new medications being tested in clinical trials work through sophisticated mechanisms that target specific molecular pathways involved in HS inflammation. Unlike older treatments that broadly suppress the immune system or fight bacteria, these newer approaches aim for precision—shutting down only the specific inflammatory signals that drive disease activity while leaving other immune functions intact.

For example, the anti-IL-17 medications prevent these inflammatory proteins from binding to their receptors on cells, essentially blocking the signal that tells immune cells to create inflammation in the skin. Anti-IL-1 therapies work similarly but target a different inflammatory pathway. By studying which patients respond best to which treatments, researchers hope to eventually personalize therapy—matching each patient with the medication most likely to work for their particular form of the disease.

Some research is also exploring whether combining different types of treatments might work better than any single approach. For instance, using a biologic medication together with laser therapy, or pairing medications that target different inflammatory pathways. These combination approaches are based on the understanding that HS involves multiple overlapping disease processes, and attacking it from several angles simultaneously might yield better results.

Most common treatment methods

• Topical treatments
  • Antibiotic gels or liquids applied to the skin (such as clindamycin) to manage mild symptoms
  • Antiseptic washes to reduce bacteria on skin surface and control odor
  • Numbing creams like lidocaine for localized pain relief
• Oral medications
  • Antibiotics including doxycycline, clindamycin, and rifampin, used alone or in combination for weeks to months
  • Oral corticosteroids for short-term use during severe flare-ups
  • Hormone therapy with medications like spironolactone or finasteride, particularly for women
• Biologic therapies
  • Adalimumab (Humira), which blocks tumor necrosis factor to reduce inflammation
  • Bimekizumab (Bimzelx), the first dual-targeted biologic that blocks both IL-17A and IL-17F proteins
  • Investigational biologics in clinical trials targeting various interleukins including IL-1 and IL-17A
• Injection treatments
  • Corticosteroid injections (triamcinolone) directly into painful lumps to quickly reduce swelling
  • Biologic medications administered as injections under the skin, typically every one to two weeks
• Surgical procedures
  • Deroofing procedures performed in the office to unroof skin tunnels
  • Drainage of painful abscesses for temporary symptom relief
  • Excision of affected tissue ranging from limited removal to wide surgical removal with possible skin grafting
• Laser therapy
  • Various laser types used to destroy hair follicles or reduce inflammation
  • Laser hair removal to decrease the number of hair follicles that may become blocked
• Pain management approaches
  • Over-the-counter or prescription pain medications
  • Referral to pain management specialists for comprehensive strategies
  • Complementary approaches including acupuncture and mind-body techniques

Supporting Your Treatment with Lifestyle Modifications

While medications and procedures form the core of HS treatment, certain lifestyle changes can significantly impact how well your treatment works and how often you experience flare-ups. These modifications aren’t substitutes for medical care, but they work alongside your prescribed treatments to help manage symptoms.

Weight management plays an important role for many HS patients. Research shows that obesity is strongly associated with more severe HS symptoms. Excess weight can increase friction in skin folds and contribute to inflammatory processes throughout the body. Losing weight, when appropriate, may help reduce flare-ups and improve response to medications, though this should be pursued under medical guidance.^[5][17]

Smoking cessation is one of the most important steps you can take. Smoking is strongly linked to HS, and continuing to smoke makes symptoms worse and reduces the effectiveness of treatments. While quitting smoking is challenging, your healthcare team can provide resources and support to help you succeed.^[5][13]

Stress management deserves special attention because stress can trigger HS flare-ups through its effects on inflammation and the immune system. Conversely, living with HS causes stress, creating a difficult cycle. Techniques like mindfulness meditation, deep breathing exercises, yoga, or working with a therapist can help break this cycle. Some patients find that support groups—either in-person or online—provide valuable emotional support from others who truly understand the challenges of living with HS.^[21]

Daily skin care practices can help prevent infections and reduce irritation. Using gentle, fragrance-free cleansers and wearing loose-fitting, breathable clothing reduces friction on affected areas. Some patients benefit from using antiseptic washes daily to keep skin clean. Avoiding shaving or using careful hair removal techniques in affected areas can prevent trauma that might trigger new lesions.^[15][16]

Dietary modifications may help some individuals, though research in this area is still developing. Some patients report that certain foods seem to trigger their flare-ups, commonly including dairy products, refined sugars, or foods in the nightshade family. An anti-inflammatory diet rich in fruits, vegetables, omega-3 fatty acids from fish, and whole grains while limiting processed foods may support overall health and potentially reduce inflammation.^[17]