Learn more about hidradenitis suppurativa.
Read about available treatments.
Learn about your hidradenitis suppurativa.
Express what is important to you.
Compare treatments with your values.
Your results and next steps.
Although there is currently no cure for HS, many treatment options are available to try to control it (Alikhan, 2016). A combination of treatments is sometimes used in order to obtain better results.
Side effects and potential for improvement will differ between treatments. The treatment options included in this PDA do not contain a complete list of side effects, specific doses, and duration of therapy. Additionally, some treatments do not have enough evidence to provide detailed information in some sections. Thus, you should talk to your health care provider to learn more about what may be best for you.
It is important to note that a drug may have different names depending on the manufacturer. Therefore, the treatment products included in this PDA are named based on their active ingredients.
The treatment options listed in the table below are based on current clinical HS guidelines. The layout of the table may appear differently depending on the device you are using to view the PDA.
| x No Treatment |
x Topical Treatments |
x Systemic Treatments |
x Biologic Treatments |
x Systemic Immunosuppressant Treatments |
x Light, Laser, and Energy Sources |
x Surgical Treatments |
x Complementary & Alternative Treatments |
|
|---|---|---|---|---|---|---|---|---|
| What is it and how does it work? |
No TreatmentWithout treatment, the natural progression of HS is typically chronic and progressive (Micheletti, 2014). |
Topical TreatmentsTopical products may come as lotions, gels, creams, or solutions, and are applied directly on the affected area(s) of the skin (Perng, Zampella, & Okoye, 2017). |
Systemic TreatmentsSystemic treatments are either taken by mouth or by injection. They travel through the bloodstream and affect different parts of the body. |
Biologic TreatmentsBiologics are products derived from living organisms that can reduce inflammation and modify the body’s immune response (Lee & Eisen, 2015). They are injected into the skin or veins (Hidradenitis Suppurativa Foundation, Inc.). |
Systemic Immunosuppressant TreatmentsSystemic immunosuppressants are medicines in pill or injectable form that target the immune system and reduce inflammation (Alikhan, Lynch, & Eisen, 2009). Biologics are a form of systemic immunosuppression. All recommended vaccines should be current before taking immunosuppressants. |
Light, Laser, and Energy SourcesLight and laser-based treatments use different mediums to emit specific wavelengths of high-energy light onto affected areas of the skin to selectively destroy tissue (Ranaweera, 2014). Ablative and non-ablative laser treatments remove tissue and selectively target tissue components, respectively. They are used in combination with medical treatment(s) to reduce the frequency of painful flares. |
Surgical TreatmentsSurgical treatments range from incision and drainage procedures to wide excisions (van Straalen, Schneider-Burrus, & Prens, 2018). They are typically reserved for cases in which medications are inadequate. Surgical outcomes are influenced by the location and severity of the affected area(s), as well as the presence of other medical conditions (Mehdizadeh, et al., 2015). In particular, the presence of recurrent or persistently draining sinuses (tunnels) and scarring often indicates a more likely need for surgical intervention. Thus, surgical treatment of HS is based on various factors, such as disease severity, treatment history and response, patient preference, and surgical expertise (Danby, Hazen, & Boer, 2015). |
Complementary & Alternative TreatmentsTreatments are termed “complementary” when they are used with mainstream medicine and “alternative” when used instead of mainstream medicine (National Center for Complementary and Integrative Health, 2016). While treatments discussed in this section have limited evidence, they may benefit some HS patients. |
| What types are there? |
No Treatment |
Topical Treatments
|
Systemic Treatments
|
Biologic Treatments
|
Systemic Immunosuppressant Treatments
|
Light, Laser, and Energy Sources
|
Surgical Treatments
|
Complementary & Alternative Treatments
|
| Who is it for? |
No TreatmentAnyone can choose to not receive treatment for their HS. |
Topical TreatmentsThose with mild to moderate HS. |
Systemic TreatmentsDifferent treatments may be used to treat different HS severities. Click the tab below to learn more. |
Biologic TreatmentsThose with moderate to severe HS. |
Systemic Immunosuppressant TreatmentsDifferent treatments may be used to treat different HS severities. Click the tab below to learn more. |
Light, Laser, and Energy SourcesDifferent sources may be used to treat different HS severities. Click the tab below to learn more. |
Surgical TreatmentsDifferent treatments may be used to treat different HS severities. Click the tab below to learn more. |
Complementary & Alternative TreatmentsAnyone with HS. |
| Who is it NOT for? |
No TreatmentThose who rapidly progressed from Hurley stage I to II, as they may likely progress to Hurley stage III (Vanlaerhoven, Ardon, van Straalen, Vossen, Prens, & van der Zee, 2018). Those who are in pain and discomfort, unable to perform usual daily activities or feeling down and depressed due to their HS. |
Topical TreatmentsSome people may have sensitivity or allergies to some of these treatments. |
Systemic TreatmentsCertain treatments should not be taken in specific circumstances. Click the tab below to learn more. |
Biologic TreatmentsCertain treatments should not be taken in specific circumstances. Click the tab below to learn more. |
Systemic Immunosuppressant TreatmentsCertain treatments should not be taken in specific circumstances. Click the tab below to learn more. |
Light, Laser, and Energy SourcesSome people may have sensitivity to light. |
Surgical TreatmentsCertain treatments should not be taken in specific circumstances. Click the tab below to learn more. |
Complementary & Alternative TreatmentsSome people may have sensitivity or allergies to some dietary supplements. |
| How well does it work? |
No Treatment
|
Topical TreatmentsResorcinol 15% cream
|
Systemic TreatmentsHormonal therapyLevel of Evidence:
Level of Evidence:
Strength of recommendation:
|
Biologic TreatmentsTumor necrosis factor alpha (TNFα) inhibitors
Infliximab (Remicade, Renflexis)
Anakinra (Kineret)
Ustekinumab (Stelara)
|
Systemic Immunosuppressant TreatmentsCyclosporine
|
Light, Laser, and Energy SourcesLong-pulsed neodymium-doped yttrium aluminum garnet (Nd:YAG) laser
|
Surgical TreatmentsWide excisionConventional scalpel
Secondary intention
|
Complementary & Alternative TreatmentsDietary modifications Zero dairy diet
|
| What are the possible side effects? |
No TreatmentHS may get better, worse or stay the same. You may experience psychological distress, sinus tract formation, scarring, pain, or drainage (Micheletti, 2014; Smith, Nicholson, Parks-Miller, & Hamzavi, 2017). |
Topical TreatmentsSerious side effects vary between treatments. They may cause redness, irritation, or peeling. Risks in pregnant or breastfeeding women vary between treatments. Click the tab below to learn more. |
Systemic TreatmentsSide effects vary between treatments. Some treatments are not safe for pregnant or breastfeeding women. Click the tab below to learn more. |
Biologic TreatmentsSide effects vary between treatments. It is not yet known if these treatments are safe for pregnant or breastfeeding women. Click the tab below to learn more. |
Systemic Immunosuppressant TreatmentsSide effects vary between treatments. Some may not be safe for pregnant or breastfeeding women. Click the tab below to learn more. |
Light, Laser, and Energy SourcesSide effects vary between treatments. It is not yet known if some these treatments are safe for pregnant or breastfeeding women. Click the tab below to learn more. |
Surgical TreatmentsA serious infection or bleeding may occur with some of these treatments. These treatments are considered safe for pregnant women and should not interfere with breastfeeding. Click the tab below to learn more. |
Complementary & Alternative TreatmentsMost treatments have no serious side effects. A nutritional deficiency may occur with some of these treatments, in which case alternative sources for these nutrients should be considered. Pregnant or nursing women should consult their health care providers before considering any major diet changes. Click the tab below to learn more. |
| Will it inconvenience me? |
No TreatmentUntreated HS may interfere with daily life and overall life quality, as it is currently one of the most distressing of all dermatological diseases (von der Werth & Williams, 2000). |
Topical TreatmentsTopical treatments are less convenient to use when the affected area is difficult to reach. They may also need to be applied often or for a long period of time. |
Systemic TreatmentsMost of these treatments may require blood tests to be performed before, during, and after treatment. |
Biologic TreatmentsSome of these treatments may require blood tests and skin examinations to be performed before treatment. |
Systemic Immunosuppressant TreatmentsThese treatments may require blood tests to be performed. |
Light, Laser, and Energy SourcesMultiple treatment sessions may be required. |
Surgical TreatmentsAn anesthetic may be used during surgery. |
Complementary & Alternative TreatmentsIt may take some time to see results when dietary changes are made. |
| x No Treatment |
x Topical Treatments |
x Systemic Treatments |
x Biologic Treatments |
x Systemic Immunosuppressant Treatments |
x Light, Laser, and Energy Sources |
x Surgical Treatments |
x Complementary & Alternative Treatments |
|---|
Last Updated: July 2019