Hidradenitis Suppurativa Treatments: Medications, Procedures, and Lifestyle Changes

Finding effective hidradenitis suppurativa treatments can be life-changing for the roughly 1–4% of people affected by this chronic, inflammatory skin condition. Hidradenitis suppurativa (HS) causes painful, recurring nodules, abscesses, and tunneling wounds, most often in the armpits, groin, buttocks, and under the breasts.

While there is no cure, the range of hidradenitis suppurativa treatments has expanded significantly in recent years, with newer biologic medications and refined surgical techniques offering better outcomes than in the past. This guide is the big-picture overview of medications, procedures, and lifestyle changes; for a deeper look focused specifically on the drugs, see our companion article on hidradenitis suppurativa medication. Everything here is drawn from guidance from the American Academy of Dermatology (AAD), the National Institutes of Health, and other authoritative sources, and it is intended as education rather than a substitute for care from your own dermatologist. It does not include drug dosing, which should come only from your prescriber.

Understanding Hidradenitis Suppurativa Severity Stages

Treatment for HS is guided by the Hurley staging system, which classifies the condition into three stages:

Hurley Stage I (Mild): Single or multiple abscesses without sinus tracts (tunnels) or scarring. Flares come and go with periods of clearer skin in between. Treatment typically involves topical and oral medications.

Hurley Stage II (Moderate): Recurrent abscesses with sinus-tract formation and scarring in one or more areas. Flares are more frequent and the disease is more persistent. Treatment often combines medications with minor procedures.

Hurley Stage III (Severe): Diffuse or widespread interconnected sinus tracts and abscesses across an entire area, with chronic drainage, significant scarring, and a substantial impact on quality of life. Treatment typically involves biologic medications and may include major surgery.

HS is frequently underdiagnosed and undertreated, and many patients wait years from the first symptoms to a correct diagnosis. Early, consistent treatment can help slow disease progression and reduce scarring, which is why getting to a dermatologist sooner rather than later matters.

Topical and First-Line Treatments

For mild HS and as add-ons to other therapies, topical treatments play an important role:

Topical clindamycin: A topical antibiotic that the AAD lists among first-line options for mild HS. It reduces bacterial colonization in HS lesions and offers modest anti-inflammatory effects. Your dermatologist will advise how long to use it.

Benzoyl peroxide wash: Used as a cleanser for HS-prone areas, it reduces bacterial load and may help prevent new flares.

Topical resorcinol: A peeling agent that can help reduce nodules and prevent new lesions. It is available by prescription in some settings and through compounding pharmacies.

Antiseptic washes: Chlorhexidine or zinc pyrithione washes used in the shower can help reduce bacteria on the skin and may decrease flare frequency.

Oral Medications

When topical treatments are not enough, oral medications provide more systemic control. Specific choices and durations are individualized by your dermatologist; the notes below are descriptive only and intentionally omit doses.

Antibiotics:

• Clindamycin plus rifampin: A widely used oral antibiotic combination for moderate HS, often given for a defined course. Rifampin has important drug interactions — notably with hormonal contraceptives — so review all your medications with your prescriber.
• Doxycycline or minocycline: Tetracycline-class antibiotics used for their anti-inflammatory properties, often as a first-line oral option for mild-to-moderate HS.
• Dapsone: Has both antibacterial and anti-inflammatory effects and may be used when other antibiotics are not tolerated or effective. It requires regular blood monitoring.

Hormonal therapies:

• Spironolactone: An anti-androgen that can reduce HS flares in some women, particularly those with hormonally driven patterns.
• Combined oral contraceptives: May help some women by modulating hormonal influences on the disease.
• Metformin: Sometimes added, especially for patients with insulin resistance, as part of a broader plan.

Retinoids:

• Acitretin: An oral retinoid that may reduce lesions and prevent new ones. It requires monitoring of liver function and lipids and must not be used in pregnancy, with strict pregnancy-prevention precautions.

Immunomodulators: Medications such as methotrexate or cyclosporine are occasionally used, though the evidence base for HS is more limited and they are generally reserved for specific situations under specialist care.

Biologic Medications

Biologic therapies represent the most significant advancement in hidradenitis suppurativa treatments and are a standard of care for moderate-to-severe disease. As of 2026, three biologics are FDA-approved specifically for HS:

Adalimumab (Humira): The first FDA-approved biologic for HS, a TNF-alpha inhibitor given as a subcutaneous injection. In clinical trials, a meaningful share of patients achieved clinically important improvement. Lower-cost biosimilar versions are now available.

Secukinumab (Cosentyx): An IL-17A inhibitor FDA-approved for moderate-to-severe HS, given as a subcutaneous injection after a loading phase. Trials demonstrated improvement in HS lesion counts and pain compared with placebo.

Bimekizumab (Bimzelx): A newer biologic that inhibits both IL-17A and IL-17F, FDA-approved for moderate-to-severe HS in adults. It is given by subcutaneous injection and adds a further option for people who have not responded adequately to earlier therapies. The AAD lists it among the approved biologic options for HS.

Other biologics used off-label:

• Infliximab (Remicade): A TNF-alpha inhibitor given intravenously. Some dermatologists consider it useful for severe HS, though it is not FDA-approved for this indication.
• Ustekinumab (Stelara): An IL-12/23 inhibitor with some supportive evidence in HS.

Pipeline therapies: Several additional biologics and small-molecule drugs, including JAK inhibitors, are being studied for HS. The NIH’s registry at ClinicalTrials.gov lists ongoing studies for patients interested in investigational treatments. For the financial side of surgical options, see our guide on hidradenitis suppurativa surgery cost.

Surgical and Procedural Treatments

Procedures range from minor office-based treatments to major surgery depending on disease severity:

Incision and drainage (I&D): Provides temporary relief of acute, painful abscesses. However, I&D alone has a very high recurrence rate because it does not address the underlying disease process. It is considered a short-term measure for acute flares, not a definitive treatment.

Deroofing: A minimally invasive procedure in which the roof of a sinus tract is removed, leaving the wound to heal from the bottom up. It is suited to isolated, recurring nodules with sinus tracts and has a lower recurrence rate than I&D.

Punch debridement: Small sinus tracts are removed using a biopsy punch tool. Useful for limited, well-defined lesions.

Laser therapy:

• Nd:YAG laser: Targets hair follicles in HS-prone areas and can reduce the number and severity of flares. Multiple sessions are typically needed.
• CO2 laser excision: Uses a CO2 laser to remove affected tissue, sometimes under local anesthesia for limited disease.

Wide surgical excision: The most definitive surgical treatment for severe, localized HS. The entire affected area is removed, including sinus tracts and scarred tissue, with margins into healthy skin. Recurrence rates after wide excision are among the lowest of any surgical approach. Wounds may be left to heal by secondary intention, closed primarily, or covered with skin grafts or flaps depending on size and location.

Pain Management

HS can be genuinely painful, and pain control is a legitimate part of treatment rather than an afterthought. Approaches may include topical measures, treating the underlying inflammation to reduce flares, and, in some cases, medications prescribed and monitored by your care team. Because HS pain can be both acute (during flares) and chronic, some patients benefit from a multidisciplinary plan that may involve a pain specialist. Talk with your dermatologist about pain that is not well controlled rather than trying to manage severe pain alone.

Lifestyle Changes and Complementary Approaches

Lifestyle modifications can meaningfully reduce flare frequency and severity:

Smoking cessation: Smoking is strongly associated with HS, and a large share of patients are current or former smokers. Quitting often leads to improvement and is one of the most impactful changes a patient can make. Ask your clinician about cessation support and medications.

Weight management: Excess weight is a well-established risk factor for HS severity, and weight loss can improve symptoms for many patients. Even modest, sustained weight loss can make a noticeable difference.

Reduce friction: Wear loose-fitting, breathable clothing to limit friction and heat in affected areas. Avoid tight waistbands, synthetic underwear, and rough seams.

Wound care: Good wound care for draining lesions includes absorbent, non-stick dressings; regular dressing changes; gentle cleansing; and avoiding adhesive bandages directly on inflamed skin.

Dietary considerations: Some patients report improvement with dairy elimination or anti-inflammatory eating patterns, though the research evidence is limited. A supervised trial elimination diet may be worth discussing with your provider.

Mental health support: HS can significantly affect quality of life, self-esteem, and mental health, and rates of depression and anxiety are higher among people with HS. Counseling, support groups, and mental health care are a valid part of comprehensive management. For broader guidance, visit our medical conditions guide.

When to See a Doctor

Because HS is chronic and progressive without treatment, prompt specialist care matters. See a dermatologist if you have recurrent painful lumps in the same areas, any tunneling or draining lesions, or scarring — even if the flares seem to come and go. Early diagnosis opens the door to treatments that can prevent progression.

Seek same-day or urgent care if a lesion shows signs of a spreading infection: increasing redness, warmth, and swelling; worsening pain; foul-smelling drainage or pus; fever or chills; or red streaks spreading from the area. These can signal a skin infection that needs prompt treatment. Go to the emergency room or call 911 for severe symptoms such as high fever with a rapidly spreading, intensely painful area, confusion, or feeling very unwell, which can indicate a serious infection.

Frequently Asked Questions

Can hidradenitis suppurativa go away on its own?

HS is a chronic condition that does not usually resolve on its own. Individual flares may come and go, but the underlying disease process continues without treatment. Some patients notice changes in severity over time, but this is not guaranteed. Early, consistent treatment is the best approach.

What triggers hidradenitis suppurativa flares?

Common triggers include friction from tight clothing, sweating, stress, hormonal changes such as the menstrual cycle, heat and humidity, shaving in affected areas, and, for some people, certain foods. Identifying and avoiding personal triggers can help reduce flare frequency.

How effective are biologics for HS?

Biologics provide meaningful improvement for a substantial share of patients with moderate-to-severe HS. Complete remission is less common, but many patients experience real reductions in pain, drainage, and flare frequency. Response can take weeks to become apparent, and long-term maintenance treatment is usually needed.

Is hidradenitis suppurativa contagious?

No. HS is an inflammatory condition related to the immune system and hair-follicle biology. It is not caused by an infection and cannot be passed from person to person. Bacterial colonization can play a role in some lesions, but the underlying disease is not infectious.

Should I see a dermatologist or a surgeon for HS?

Start with a dermatologist, ideally one experienced in HS. Dermatologists manage the medical plan, including medications and minor procedures. If surgery is needed, your dermatologist can refer you to a surgeon experienced in HS. Some academic medical centers have dedicated HS clinics with multidisciplinary teams.

Work With Specialists for the Best Outcomes

Hidradenitis suppurativa treatments have improved dramatically in recent years, offering real hope for symptom control and better quality of life. Start with a dermatologist experienced in HS, pursue early and consistent treatment to help prevent progression, and incorporate lifestyle changes that reduce flare triggers. Whether your plan centers on topical treatments, biologics, surgery, or a combination, ongoing care and follow-up are key to the best possible outcomes.

Sources

• American Academy of Dermatology (AAD) — hidradenitis suppurativa diagnosis, treatment, and approved biologics
• National Institutes of Health / MedlinePlus — hidradenitis suppurativa overview
• Cleveland Clinic — hidradenitis suppurativa symptoms and treatment
• ClinicalTrials.gov (NIH) — ongoing HS clinical studies