Hidradenitis suppurativa

Everyday steps that reduce rubbing, heat, and irritation in the folds, such as loose breathable clothing, gentle washing without scrubbing, and avoiding waxing.

Often discussed for almost everyone with HS, alongside other care, because friction and heat are common flare triggers.

These steps help but rarely control moderate or severe HS alone. They should not replace medical care when lumps are frequent or painful.

Deodorants or products with fragrance, alcohol, or baking soda can sting or irritate. If a product burns or a rash appears, tell your clinician.

Small changes may help within weeks, but benefits are usually modest and gradual.

• Which products and clothing fit best with my skin and flares?
• Is shaving, trimming, or laser hair reduction ever a good idea for me?
• Do you recommend a deodorant or antiperspirant type?

Ways to ease pain and manage draining lumps, such as warm compresses, absorbent non-stick dressings, and over-the-counter or prescription pain relief chosen with your clinician.

Often discussed for anyone with painful or draining lumps, since pain is one of the hardest parts of HS and can be treated.

Some pain relievers are not right for people with stomach, kidney, liver, or heart conditions, or during pregnancy. Adhesive dressings can irritate sensitive folds.

Pain that keeps rising, signs of infection, or dressings that stick or tear skin. Please speak up about pain, as it is a valid symptom to treat.

Relief from compresses and dressings can be quick, but long-term pain usually improves only when the HS itself is controlled.

• What pain relief is safest for me?
• What dressings work best for draining lumps?
• Can you refer me to a pain specialist if needed?

Over-the-counter skin washes, such as benzoyl peroxide or zinc pyrithione washes, that are used on the skin to lower bacteria and sometimes calm early lumps.

Often considered for mild HS or as an add-on to other care, as part of a plan a dermatologist outlines.

May be too drying or irritating for sensitive skin or open wounds. Benzoyl peroxide can bleach fabrics and towels.

Dryness, stinging, or redness. On brown and Black skin, ongoing irritation can leave dark marks, so tell your clinician early if skin is irritated.

Often judged over several weeks to a few months.

• Is an antiseptic wash a good fit for my type of HS?
• How do I protect sensitive folds from irritation?
• What should I do about open or draining areas?

Creams, gels, or lotions applied to lumps or folds. Examples include the antibiotic clindamycin and resorcinol, a peeling-type cream.

Often considered for mild HS, or for a few limited areas, before or alongside stronger treatments.

Less likely to be enough when there are many lumps, deep lumps, or tunnels. Skin allergy or sensitivity to an ingredient may rule one out.

Dryness, burning, or peeling. Antibiotic creams used alone for long periods can become less effective, so clinicians usually plan their use carefully.

Often judged over about 3 to 4 months.

• Would a topical medicine be enough for my pattern of HS?
• How will we know if it is working?
• What is the plan if it does not help?

Procedures range from steroid injections into a painful lump, to drainage, to deroofing (opening and removing the top of a tunnel so it can heal), to surgery that removes affected skin. Laser hair reduction is sometimes used too.

Often considered for a single painful lump, for tunnels that keep draining, or for areas that do not respond to medicine. Surgery is often paired with medical treatment.

Active widespread infection, bleeding risks, or some health conditions may change timing. Large surgery may need planning around healing and other treatments.

Pain, bleeding, infection, slow healing, and scarring. Lumps can return near the treated area, and dark or thick scars are more likely on some skin tones.

Healing may take weeks to months depending on the procedure.

• Which procedure fits my lumps or tunnels?
• What is wound care like afterward, and how long is recovery?
• Could medicine help me heal better before or after?

Antibiotic pills, often from the tetracycline family, used for their anti-inflammatory effect as well as for fighting bacteria. For more severe disease, clinicians sometimes combine two antibiotics.

Often considered when HS is more widespread than a few lumps, or when topical care has not been enough.

Tetracycline-type medicines are generally avoided in pregnancy and in young children. Allergies, other medicines, and past reactions matter.

Stomach upset, sun sensitivity, yeast infections, and in rare cases serious reactions. Combination antibiotics need monitoring.

Clinicians often judge response over several weeks to a few months. Flares can return after stopping.

• Which antibiotic family fits me, and what are the main risks?
• How long might I take it, and how will we review it?
• What is the plan if flares return after I stop?

Medicines that affect hormones, such as birth control pills or spironolactone, which may help some women whose flares follow their cycle.

May be discussed for women whose HS flares around periods, who also have other hormone-related signs, or who want options besides antibiotics.

Not suitable for everyone. Spironolactone is avoided in pregnancy, and estrogen-containing pills are not right for people with certain clot, migraine, or smoking-related risks.

Menstrual changes, breast tenderness, dizziness, and blood pressure or potassium changes that a clinician may check.

Often judged over about 3 to 6 months.

• Could hormones play a role in my flares?
• Are these medicines safe if I may become pregnant?
• What checks would I need while taking one?

Biologics are injected or infused medicines that block specific parts of the immune system. In the U.S., three are FDA-approved for adults with moderate to severe HS: adalimumab (Humira and biosimilars), secukinumab (Cosentyx), and bimekizumab (Bimzelx). Others are still being studied.

Often considered when HS is moderate to severe, or when other treatments have not controlled it well enough.

Not usually used with active serious infection. Clinicians screen for hidden infections such as tuberculosis and hepatitis first, and review other health conditions and pregnancy plans. Not all are suitable for people with some bowel conditions.

Higher chance of infections, injection-site reactions, and rare serious side effects. Your clinician will explain what to report.

Response is often judged after about 3 months or more. They may reduce symptoms but are not a cure.

• Is my HS at a stage where a biologic may be discussed?
• Which tests do I need first, and how often will I be monitored?
• How would insurance coverage and approval work for me?

Support to stop smoking and, if a person wishes, to reach a healthier weight. Both are linked to HS severity, and some studies show fewer flares after change.

Often discussed alongside medical treatment for people who smoke or who carry extra weight, with a kind, no-blame approach.

Weight goals should be personal and safe. Crash or very restrictive plans are not advised, and these steps are not suitable as the only treatment for active HS.

Weight and smoking are not the cause for everyone, and HS occurs in people of every size who do not smoke. Feeling blamed can hurt mental health.

Changes in flares, if they occur, usually appear over months.

• What support is available to help me quit smoking?
• Can you refer me to a nutrition or weight-care program?
• Are any weight medicines appropriate for me?