Hidradenitis Suppurativa (HS) Treatment Options

Hidradenitis suppurativa (HS)sometimes called acne inversais a chronic, inflammatory skin condition that tends to show up where skin rubs together (think underarms, groin, buttocks, and under the breasts). It’s not a “you didn’t wash enough” problem, and it’s not contagious. It’s more like your hair follicles and immune system threw a recurring house party and forgot to invite your comfort. The good news: while there isn’t a single one-and-done cure, there are many treatment options that can reduce flare-ups, calm inflammation, help wounds heal, and prevent the condition from marching into more severe territory.

HS treatment is rarely one magic product and a wish. It’s usually a personalized combo of skin-care basics, medications, and sometimes procedures or surgerypicked based on how severe your HS is, where it shows up, and what your body tolerates. If you’ve ever felt like you’re doing “trial-and-error: the director’s cut,” you’re not alone. Dermatologists expect that HS management may take adjustments over time, and follow-up visits are part of the plan.

Why HS Treatments Vary So Much: Severity (Hurley Stages) Matters

Clinicians often describe HS using the Hurley staging system. You don’t need to memorize it like a final exam, but it helps explain why one person improves with topical medication while another needs biologics or surgery.

Hurley Stage I (mild)

Typically: isolated or occasional painful bumps or abscess-like lesions, without long-standing tunnels (sinus tracts) or extensive scarring. Treatment often starts with topical therapy, targeted lifestyle changes, and early anti-inflammatory strategies.

Hurley Stage II (moderate)

Typically: recurring lesions with scarring and some tunnels; lesions may be more widespread. Treatment often escalates to oral medications, hormonal or metabolic options (when appropriate), and in-office procedures like injections or deroofing for stubborn tunnels.

Hurley Stage III (severe)

Typically: extensive tunnels, scarring, and more continuous inflammation across a region. Treatment frequently involves a combination approachsystemic medications (including biologics) plus surgical strategies to remove chronic tunnels and scarred tissue.

What Treatment Is Trying to Do (Besides “Make It Stop”)

HS treatment goals are practical and measurable:

• Reduce inflammation so fewer painful nodules and abscesses form.
• Shorten flares and increase symptom-free time.
• Control drainage and odor by helping lesions heal and preventing secondary infection.
• Prevent tunnels and scarring (or stop them from spreading).
• Improve quality of life, including movement, sleep, and mental health.

Foundation Moves: Daily Care That Makes Medical Treatments Work Better

Think of daily HS care like setting the stage: it doesn’t replace medical treatment, but it can reduce friction (literally) and help prevent flare triggers from piling on.

Reduce friction, heat, and irritation

• Choose loose, breathable clothing to reduce rubbing in affected areas.
• Manage heat and humidity when possible (sweat + friction is HS’s favorite duo).
• Avoid shaving methods that nick or irritate the skin; ask your dermatologist about safer hair-management options.

Use skin-friendly wash and deodorant/antiperspirant choices

Some soaps and deodorants can irritate HS-prone skin. Many dermatologists recommend gentle, non-irritating options and may include an antibacterial wash in your routine if it helps reduce flares. If underarm HS is part of your story, switching to a mild antiperspirant (without common irritants like fragrance or harsh additives) can be a surprisingly meaningful upgrade.

Weight management and smoking cessation (the “boring but powerful” category)

If you’re overweight, gradual weight loss can reduce friction and inflammation and may lessen HS flare frequency for some people. Quitting smoking is also strongly associated with improvement in many patients. These aren’t moral judgmentsHS isn’t a punishmentbut they are modifiable factors that can meaningfully shift the disease course.

Wound care: follow a plan, not vibes

HS wounds can be stubborn. If your dermatologist gives you a wound-care plan (dressings, cleansing steps, topical medications), following it consistently helps wounds heal and can prevent complications. If a wound re-opens, gets more painful, or doesn’t heal, it’s worth checking in.

Medications for Mild to Moderate HS

Medications for HS generally aim to calm inflammation, reduce flare frequency, and help lesions heal. Depending on severity, these can be topical (applied to skin), oral, injectable, or infused. Your clinician will tailor choices to your medical history, pregnancy status (if relevant), and other conditions.

Topical treatments

• Topical clindamycin is commonly used for mild HS and may reduce inflammatory lesions.
  It’s not a “miracle spot sticker,” but it can be an effective first-line option for some people.
• Resorcinol (often discussed as a peeling/keratolytic agent) may help open clogged follicles and reduce inflammation in certain cases.
  It can irritate skin for some people, so it’s best used with clinician guidance.

Oral antibiotics (often used for inflammation, not just infection)

Antibiotics are frequently prescribed in HS. While antibiotics do treat bacterial overgrowth and secondary infection when present, they’re also used because some regimens have anti-inflammatory effects. Courses can be short or longer, and sometimes combinations are used for more persistent diseasealways under medical supervision to reduce side effects and resistance risk.

Short-term inflammation control: injections and targeted strategies

For especially angry, painful lesions, clinicians may use in-office treatments like corticosteroid injections into a lesion to reduce inflammation. This can sometimes shrink a flare faster and ease painthink of it as a “calm down” button for a specific trouble spot, not a whole-body strategy.

Hormonal and metabolic options (especially when patterns suggest a role)

HS can flare around hormonal shifts for some people. In those situationsoften in womenhormonal therapy may be helpful. Options a dermatologist might consider include certain birth control pills, spironolactone, and other hormone-modulating medications. Metformin is sometimes used when insulin resistance or metabolic factors may be contributing. These are not “one-size-fits-all,” and they’re not right for everyone, but they can be game-changers for the right patient profile.

Pain relief as part of treatment (not an afterthought)

HS pain can be intense, and managing it matters. Pain relievers may be used, along with strategies that reduce friction and protect wounds. If pain is frequent, severe, or affecting sleep or movement, it’s worth discussing a structured pain plan with your clinician (and not just white-knuckling it).

Biologics and Advanced Systemic Therapies for Moderate to Severe HS

When HS is moderate to severeor when it’s not responding to more conservative treatmentsbiologic medications may be considered. Biologics target specific immune pathways involved in inflammation. They’re powerful, and they come with important safety considerations (like infection risk and monitoring), so the decision is individualized.

FDA-approved biologics for HS (U.S.)

• Adalimumab (a TNF inhibitor) is FDA-approved for moderate to severe HS, including certain adolescent patients.
• Secukinumab (an IL-17A inhibitor) is FDA-approved for adults with moderate to severe HS.
• Bimekizumab (targets IL-17A and IL-17F) is FDA-approved for adults with moderate to severe HS.

Some patients may also be prescribed other systemic immunomodulators or biologics off-label (for example, infliximab infusions are sometimes used in specialized care settings). Because biologics affect immune activity, clinicians typically screen and monitor patients according to prescribing guidance.

What “success” looks like with biologics

With biologic therapy, clinicians track outcomes like fewer inflammatory nodules/abscesses, less drainage, reduced pain, fewer new tunnels, and improved quality of life. Some people respond dramatically; others respond partially; some need a different strategy. If you’re not seeing improvement, that doesn’t mean you “failed”it means HS is being HS, and your plan may need to evolve.

Procedures and Surgery: When HS Needs a Mechanical Fix

HS can create tunnels and chronic pockets of inflammation that don’t respond fully to medication alone. That’s where procedures come in. A good rule of thumb: medications calm the biology; procedures address the architecture.

Incision and drainage (I&D): fast relief, but usually temporary

Draining a painful abscess can provide quick relief, but it often doesn’t prevent recurrence because the underlying HS process remains. Many clinicians reserve this for urgent symptom relief rather than long-term control.

Deroofing (unroofing): a tissue-sparing option for tunnels

Deroofing removes the “roof” over HS tunnels and chronic lesions so the area can heal from the inside out. It’s often used for persistent abscesses or sinus tracts, and studies suggest it can improve quality of life and reduce recurrence in treated spotsespecially when paired with ongoing medical therapy.

Excision (including wide excision): for extensive, severe disease

For severe HS with extensive scarring and tunnels, surgical excision removes diseased tissue more definitively. Depending on the size and location, closure might involve secondary healing, stitches, skin grafts, or flaps. This is usually considered when disease is advanced or repeatedly returns in the same region.

Laser approaches: hair reduction and CO₂ laser options

Laser hair removal (often using devices like Nd:YAG in appropriate patients) may reduce flares in some people by reducing hair and follicular activity in affected areas. CO₂ laser can also be used in certain procedural strategies, including for tunnels in specialized settings. Lasers aren’t a universal solution, but they can be a useful tool in the right hands.

Whole-Person HS Care: Comorbidities, Mental Health, and the “Invisible Work”

HS is more than skin-deep. Many reputable clinical reviews emphasize that quality of life is often heavily affected, and screening for depression is important. Some people with HS also experience joint symptoms or inflammatory conditions that need attention. Good HS care often involves coordination between dermatology, primary care, and sometimes surgery, pain management, or mental health support.

A Practical Treatment Roadmap (Three Example Paths)

Every HS case is different, but these examples show how treatment options often stack together in real clinical practice.

Example 1: Mild HS (Hurley I) in underarms

• Gentle skin-care plan (reduce irritation; choose non-irritating antiperspirant).
• Topical therapy such as topical clindamycin; consider resorcinol with guidance if appropriate.
• Behavioral friction fixes: looser clothing, reduce heat/sweat triggers, protect skin from shaving irritation.
• Track flares for 6–8 weeks to identify patterns (stress, heat, menstrual cycle, certain products).

Example 2: Moderate HS (Hurley II) with recurring lesions and early tunnels

• Continue topical regimen plus oral anti-inflammatory antibiotic strategy if appropriate.
• Consider hormonal/metabolic options if the clinical pattern fits (for example, cyclical flares).
• In-office lesion injections for severe, localized flares.
• Deroofing for persistent tunnels that keep refilling like a bad recurring subscription.

Example 3: Severe HS (Hurley III) with extensive tunnels and scarring

• Systemic therapyoften biologicsto reduce widespread inflammation.
• Strategic surgical planning (excision/deroofing) to remove chronic tunnel networks.
• Structured wound care plan and follow-up schedule.
• Support for pain, sleep, mobility, and mental health as part of the core plan.

When to Seek Care Quickly

HS flares can be painful and draining (emotionally and literally), but there are times you shouldn’t “wait it out.” Contact a clinician promptly if you develop fever, rapidly worsening redness or swelling, severe pain that’s escalating, or if a wound seems to be getting significantly worse instead of gradually healing. If you feel unwell overall, seek urgent careespecially if you’re on immune-modulating medication.

Key Takeaways

• HS treatment is individualized and often layered: daily care + medication + procedures when needed.
• Early treatment can help prevent tunnels and scarring from becoming the main event.
• Topicals and lifestyle changes can help mild disease; moderate to severe disease may need systemic therapy and/or procedures.
• FDA-approved biologics for HS in the U.S. include adalimumab, secukinumab, and bimekizumab for appropriate patients.
• Procedures like deroofing and excision can be essential when HS creates tunnels that medication alone can’t undo.

Experiences People Commonly Share About HS Treatment (Added)

If you ask people living with HS what treatment is like, many will tell you it’s not a straight lineit’s more like a GPS that periodically reroutes because HS decided to “take the scenic route” through your week. One of the most common experiences is realizing that HS care is a system, not a single product. Someone might start with topical medication and gentle skin care, feel better for a few months, then hit a flare triggered by heat, stress, friction, or hormonal changes. That can feel discouraginguntil you learn that flares don’t always mean your plan is useless; they often mean your plan needs an adjustment.

Another shared experience is that the “small stuff” matters more than you’d think. People often mention that switching to looser clothing, choosing less irritating deodorants, and getting serious about wound-care routines changed their day-to-day comfort. Not glamorous, but very real. Many also describe building a “flare kit” at home: gentle cleanser, non-stick dressings, medical tape that doesn’t bully your skin, and an extra shirt “just in case.” It’s not the kind of collection anyone asks forbut it can reduce anxiety because you’re prepared instead of improvising with a paper towel and hope.

A lot of patients talk about the emotional side: the unpredictability, the embarrassment about drainage or odor, the frustration of canceling plans, and the feeling that your skin is running a private drama series without your permission. This is why so many reputable clinicians emphasize quality-of-life screening and mental health support as part of HS care. People often describe feeling relieved when a dermatologist treats HS like the legitimate inflammatory condition it isnot a hygiene lecture. (If you ever got the hygiene lecture, please know: HS is not a character flaw.)

When treatment escalates to systemic medications or biologics, experiences vary widely. Some people report significant improvementsfewer lesions, less pain, and more “normal” weeks. Others describe partial improvement: fewer severe flares, but not complete control. It’s also common to hear that biologics feel like a big step emotionally (“Do I really need this?”) because they come with monitoring and safety discussions. Many patients say the most helpful thing was a clear conversation with their dermatologist about what success looks like: not perfection, but measurable progress over monthslike fewer draining tunnels, fewer new lesions, and better ability to move and sleep.

Procedures like deroofing can be their own chapter. People often describe being nervous about the idea of surgery, then surprised that a targeted procedure could stop one specific spot from repeatedly flaring. The best experiences tend to happen when procedures are paired with ongoing medical therapy and a realistic healing plan. Healing can take time, and that’s another recurring theme: HS treatment rewards patience more than anyone wants to admit. Progress is often measured in “before and after” photos, symptom diaries, and the quiet victory of realizing you went two months without a flare in your worst area.

Finally, many people say the biggest unlock was learning to advocate for themselves. That might mean asking for a referral to a dermatologist with HS experience, bringing photos to appointments (because HS loves disappearing the moment you walk into the clinic), or requesting a stepwise plan with clear “if-then” decisions. Example: “If topicals plus lifestyle changes don’t reduce flares after X weeks, what’s next?” That kind of roadmap turns HS treatment from a guessing game into a strategyand while HS may still be dramatic, you’ll feel less like you’re improvising in the dark.