Hidradenitis suppurativa (HS) is a rare skin condition that causes pimple-like bumps, cysts, or boils to develop in areas where skin rubs together. The most common areas are the groin and armpits. It can also appear under the breasts, in stomach folds, and between the buttocks. As the disease progresses, the bumps become painful, break open, and drain pus.
HS is a difficult condition to face—physically and mentally. Although there is not yet a cure for HS, doctors manage the condition by preventing breakouts, draining the lesions, and in some cases, using skin grafts to repair damaged areas. However, doctors try to treat the disease with medications before recommending surgery.
Doctors use many different classes of drugs to treat HS. For several of these classes, there are a variety of drug agents within them.
The classes of HS drugs include:
- Antibiotics. Although HS is not an infection and is not contagious, antibiotics can help control it. They work by decreasing inflammation and preventing secondary infections.
- Biologics. The immune system likely plays a role in HS by over-reacting to clogged hair follicles. Biologics suppress the immune system’s response.
- Corticosteroids. These drugs have powerful anti-inflammatory effects to help control breakouts.
- Hormones. Because HS occurs after puberty, experts believe hormones may contribute. Hormone therapy works by decreasing the influence of androgens—or male hormones—in both men and women.
- Immunosuppressants. These are non-biologic drugs that reduce the immune system’s activity.
- Oral retinoids. This class of drugs works by decreasing inflammation and reducing the rate of skin cell turnover.
Antibiotics are a mainstay of HS treatment. If your doctor diagnoses HS, you will likely start with an antibiotic. Skin care and lifestyle changes, such as losing weight, may also help some people. However, everyone responds to treatment differently. It may be necessary to add other classes of drugs to control HS. Doctors usually reserve biologics for HS resistant to first-line drugs like antibiotics.
Within each class, your doctor has choices to make. Finding the right choice for you may involve some trial and error. Ten drugs doctors commonly prescribe for HS include:
- Adalimumab (Humira) is a biologic injection. It is the first FDA-approved treatment for HS. Doctors use it to treat moderate to severe HS.
- Clindamycin topical (Cleocin T) is an antibiotic you apply to the skin. The advantage is you can avoid side effects that may occur when you take the medicine by mouth.
- Cyclosporine (Gengraf, Neoral, Sandimmune) is an oral immunosuppressant. Its main use is preventing transplant rejection.
- Finasteride (Proscar) is a form of hormone therapy. It blocks production of male sex hormones. It also treats BPH (benign prostatic hypertrophy) and male pattern baldness.
- Isotretinoin (Accutane) is an oral retinoid. It is a mainstay of nodular acne treatment. Women must avoid pregnancy while taking this drug.
- Metformin (Glucophage) is an oral medication for type 2 diabetes. Experts believe it helps HS by decreasing the influence of androgen hormones.
- Methotrexate (Rheumatrex) is an oral immunosuppressant. It is also a treatment for certain cancers and other autoimmune diseases.
- Norethindrone/mestranol (Necon 1/50) is an oral contraceptive. In HS, it works as a hormone therapy to balance sex hormones in females.
- Prednisone (Deltasone) is a corticosteroid. Generally, corticosteroids are for short-term use during outbreaks. Long-term use can cause side effects.
- Spironolactone (Aldactone) is a form of hormone therapy. It is a potassium-sparing diuretic that also blocks the effects of androgens.
Researchers continue to study treatments for HS. Current studies are looking at the effectiveness of radiotherapy, laser therapy, botulinum toxin (Botox), and newer biologics. This includes apremilast (Otezla), etanercept (Enbrel), infliximab (Remicade), and secukinumab (Cosentyx).
Early diagnosis and treatment can help control HS symptoms, prevent new lumps from developing and prevent complications.
