Getting a diagnosis of hidradenitis suppurativa (HS) can leave you with questions. So, what now? What can I do? While it’s true that there’s currently no cure for HS, it turns out there are lots of ways to reduce pain and prevent flares. Some treatments you get through your doctor, but you can also make choices at home to manage HS.
Symptoms of HS (and related stress!)
HS can look like acne or other skin conditions, so a dermatologist is usually your best bet for getting a solid diagnosis.
If you’ve got HS, you may have breakouts that look like pimples or boils. They often crop up on your skin in the armpits, under the breasts, on the genitals, lower abs, inner thighs, and
around the anus, but they can appear anywhere.The pimples may come and go. They are deep, tender nodules that may develop tracts that link up. If you have HS, the boils can turn into abscesses, which may drain fluid and blood. Scars may develop over time and you may get dark areas that look like blackheads.
The physical pain from HS symptoms can cause emotional distress as well. Many people with HS also feel symptoms of depression and anxiety. A large study found that 24 percent of the participants with HS had mental health conditions as well. To help manage this aspect of the HS experience, your doctor may recommend counseling or a support group.
Medication
Your doctor may recommend different types of medication for HS. These might help you to manage flares, treat breakouts, and reduce the inflammation that can worsen HS.
Topical treatments
There is some evidence that treating an affected area with a topical therapy could help with inflammation and bring things down a notch.
Some topical treatments include:
- povidone iodine
- chlorhexidine
- clindamycin
- hydrogen peroxide
- triclosan
- azelaic acid
- retinoids
Some of these need to be prescribed by a dermatologist. Your doctor can make suggestions around what might help.
Pain management
There are a number of options for handling the pain of HS. Dermatologists recommend that treating the underlying condition is the best solution to help with pain management, but there are some other items in the tool kit to help you through flares and discomfort.
You can use home treatments like ice packs or lidocaine to manage pain by applying these to your skin. Your doctor can also prescribe a stronger pain medication.
If you’ve ever tried acupuncture, you may find this also helps with HS pain.
Sometimes a combination of pain therapies works best. You might combine topical lidocaine and ice packs with an over-the-counter pain medication like ibuprofen.
Your doctor can also prescribe medications like gabapentin and pregabalin.
Antibiotics
It is sometimes possible for HS to cause a bacterial infection. Your doctor may take a swab to check for infection and prescribe a short course of antibiotics. They may also recommend a longer course of antibiotics to manage inflammation.
Biologics
Biologics are different from other medications because they are made from “living” sources, like plant or animal cells, or microorganisms. Biological sources, you could say.
So far, there’s only one biologic medication, adalimumab, that’s FDA-approved for HS. But your doctor might also recommend another biologic that may help. This kind of prescribing is called “off-label” use. Biologics typically work on your immune system.
The American Academy of Dermatology Association (AADA) notes that adalimumab is a strong medication and it’s not right for everyone. It is most often for moderate to severe HS.
Your doctor can talk about how biologics may affect you, both in terms of side effects and how they might help you manage HS.
Corticosteroids
Doctors sometimes use injectable corticosteroids in lesions to help with inflammation. Your dermatologist might only go this route if a lesion is particularly stubborn. Using steroids for too long can sometimes worsen HS, and comes with side effects.
Hormonal medications
Spironolactone or finasteride, anti-androgen hormones, might also help manage HS.
Retinoids
Your dermatologist might prescribe acitretin, an oral retinoid that may help with skin growth.
Oral antibiotics
You may be prescribed clindamycin, rifampin, metronidazole, or multiple forms of antibiotic.
Metformin
Metformin is a drug used to treat diabetes and prevent metabolic syndrome, which is associated with HS.
Lifestyle habits (yes, there are things you can do!)
In addition to working with your doctor, there are things you can do at home to help with your symptoms. These changes can often make your medication work better and help you manage HS regularly.
Diet and supplements
There’s been some evidence that diet can help reduce the symptoms of HS. A small study found that sticking to a Mediterranean diet — which focuses on plant-based foods like legumes, nuts, whole grains, fruits, and olive oil — can make HS less severe.
A 2015 research review recommended eliminating dairy and sticking to a low glycemic diet for HS. That’s in response to the theory that hormones can cause the various physical factors that lead to HS lesions.
Changing smoking behaviors
Smoking is strongly associated with HS. So, one way to help manage HS is to eliminate or reduce your tobacco use. Stomping out a smoking habit isn’t easy, but it may make a big difference.
You can ask your doctor for help quitting, or take advantage of resources like the Centers for Disease Control and Prevention (CDC)’s How to Quit Smoking guide.
Personal hygiene and clothing
Friction from clothing can sometimes cause pain, so wearing loose clothing can make things more comfortable. You might also want to try personal care products, like antiperspirants and soaps, designed for sensitive skin.
Since everyone’s HS activity is a little different, keeping a journal of products and clothing that cause flares may be your best guide for what to keep away from your skin.
Surgical options
Advanced HS can cause changes in the skin that are sometimes difficult to manage. Your doctor may recommend surgical options to help with healing and to prevent lesions from coming back.
Laser surgery
If your HS is stable for several weeks and managed with medication, a dermatologist may be able to treat the HS with lasers. It can take several months after the treatment for the skin to fully heal.
A research review found that larger studies are needed, but there is evidence that laser therapy can have a positive effect for people with HS.
Surgical removal of lesions
Traditional surgery might also help with removing lesions to allow the skin to heal. These options include:
- Incision and draining of an abscess. This may help relieve pain, as the pus-filled lump is removed. The lumps frequently come back, however, so this isn’t a permanent solution.
- Deroofing. This involves cutting an abscess or tunnel under the skin and leaving it open. Leaving the wound open to heal reduces the chances of the lesion coming back.
- Wide excision. This involves removing a lesion, like a tunnel under the skin, and leaving it open to heal, as with deroofing.
Your doctor may recommend nonsurgical options before any of these procedures, in part to manage the HS and make surgery easier for your lovely body.
The takeaway
HS doesn’t currently go away, but you can still take action to treat it. There’s lots you can do at home through diet, skin care, and clothing choices to ease the pain and stress. Your doctor can help you, too, with medication, surgery, and mental health resources.
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