Hidradenitis Suppurativa (HS) Treatments: Understanding Your Options

What is hidradenitis suppurativa?

HS is a condition that causes nodules to form under the skin. These nodules can be very painful and may form abscesses. In severe cases, you may have sinus tract formation. This is when the lesions join together to form tunnels underneath the skin. These tunnels may drain. 

HS lesions usually happen in areas where skin folds are common. You may find HS nodules in these areas:

• Around the anus

• Armpits

• Groin

• Underneath the breasts

Based on your symptoms, a healthcare professional will decide how severe your HS symptoms are using the Hurley stages: 

• Hurley stage 1 (mild): You’ll typically have one or more nodules or abscesses. But there’s no sign of sinus tracts.

• Hurley stage 2 (moderate): You’ll likely have repeat episodes of nodules or abscess formation. There are likely sinus tracts in separate areas, along with scarring. 

• Hurley stage 3 (severe): You’ll have a large area of lesions with repeated abscess and sinus tract formation. 

What are the treatment options for hidradenitis suppurativa?

The goal of treating HS is to reduce flare-ups and scarring. There are different options for HS treatment, depending on your Hurley stage:

• Topical treatments (medication applied directly to HS lesions)

• Oral medication (taken by mouth to decrease HS flare-ups)

• Injectables (medication taken by injection to lower inflammation)

• Surgery 

What causes hidradenitis suppurativa?

HS is caused by a combination of factors, like: 

• Blocked hair follicles and sweat glands

• Bacteria

• A strong immune response leading to chronic inflammation

It’s not entirely clear why this happens, but certain risk factors may make HS more likely to occur in some people. These include:

• Family history of HS

• A higher body weight

• Smoking

• Genetic variation

What triggers hidradenitis suppurativa flare-ups?

Experts don’t know exactly why some people have HS flare-ups. But they have found some triggers. Cigarette smoking is the most common trigger for HS. Up to 9 in 10 people living with HS smoke cigarettes. 

Other triggers for HS flare-ups include:

• Hormonal changes (like before the monthly menstrual cycle or after pregnancy)

• Weight gain

• Stress

• Skin trauma (such as from shaving, excess friction, and tight clothing)

• Excessive heat or sweating

Does hidradenitis suppurativa ever go away?

There’s no cure for HS. But you can successfully manage the condition. Managing your triggers can help to reduce flare-ups and increase the time between HS lesions. 

Tips for living with hidradenitis suppurativa

You and your healthcare team will work together to develop a treatment plan to manage your HS. Here are some other helpful tips for living with HS:

• Use antimicrobial soap to lower the number of bacteria on your skin.

• Stop smoking (or don’t start).

• Apply mild deodorants and avoid strong irritants.

• Manage your weight.

• Choose loose-fitting clothes, and avoid tight clothing to avoid skin friction.

• Don’t scrub your skin too hard.

• Use warm compresses for nodules as needed for comfort. 

There has been some research on whether HS is linked to vitamin deficiencies. Although the studies are small and relatively new, there may be a link with HS and low levels of:

• Vitamin A

• Vitamin D

• Vitamin B12

• Zinc

Talk with a healthcare professional about your risk of vitamin deficiency before adding any supplements to your diet. 

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Written by:

Valerie Emuakhagbon, MD

Valerie Emuakhagbon, MD, is a board-certified colorectal surgeon. A native of Dallas, Texas, she completed the six-year BA/MD program at the University of Missouri-Kansas City.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

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