Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition that manifests as painful, recurring lesions in areas like the armpits, groin, and under the breasts. This disease is characterized by deep-seated nodules and abscesses that can rupture, drain pus, and eventually form interconnected tunnels beneath the skin called sinus tracts. HS is not caused by poor hygiene, but rather involves the blockage and rupture of hair follicles, leading to intense inflammation. Successfully managing this condition requires a multi-faceted approach, focusing specifically on healing the associated wounds and preventing future activity.
Immediate Home Care for Active Wounds
Maintaining a strict, gentle hygiene routine prevents secondary infection and irritation in active HS wounds. When cleansing the affected area, use warm water and a mild or antimicrobial soap, such as one containing chlorhexidine or zinc pyrithione. Avoid aggressive scrubbing or rubbing, which can worsen inflammation and slow the healing process. After cleansing, gently pat the area dry with a soft towel.
Warm compresses can be effective for lesions, as the heat helps increase blood flow to the area. Applying a clean cloth soaked in warm water to the abscess for about 10 to 15 minutes, several times a day, can encourage softening and drainage. However, never attempt to squeeze or pick at a lesion, as this raises the risk of infection, further inflammation, and scarring.
For wounds that are actively draining, proper dressing is necessary to manage exudate and protect the skin. Non-adherent dressings are preferred, as they will not stick to the open wound bed and cause trauma upon removal. Highly absorbent materials like foam dressings or gauze pads should be used to soak up drainage. Dressings must be changed frequently to maintain a clean, dry environment that promotes healing.
Managing Pain and Inflammation
Effective pain control is necessary during an HS flare-up. Over-the-counter (OTC) non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are often the first line of defense, as they work to reduce both pain and swelling. Acetaminophen is another OTC option that can help manage mild to moderate pain.
Topical pain relievers can be applied directly to the affected area. Creams and patches containing lidocaine can numb the skin, providing short-term comfort. Some individuals also find relief using anti-inflammatory ointments or products that contain soothing ingredients like menthol or camphor.
Temperature therapy is useful for symptom management. While warm compresses encourage drainage, a cold pack or ice wrapped in a towel can be applied to non-draining, inflamed nodules. The cold temperature helps to constrict blood vessels, which reduces swelling and provides a numbing effect against acute pain.
Strategies to Minimize Flare-Ups and Scarring
Preventative lifestyle modifications reduce the frequency and severity of HS flare-ups. Minimizing friction on the skin is a straightforward strategy, involving wearing loose-fitting, breathable clothing made from natural fibers like cotton. Avoiding tight waistbands, restrictive underwear, and stiff fabrics in areas prone to HS lesions can significantly reduce mechanical irritation.
Body weight management is associated with reduced HS activity, as excess weight can increase skin-on-skin friction and inflammation. Losing even a modest 10% of body weight can lead to improved symptoms. Smoking cessation is one of the most impactful changes, as tobacco use is strongly linked to increased HS severity and recurrence.
Identifying and eliminating dietary triggers can also help reduce flare-ups. Common culprits include dairy products and foods containing brewer’s yeast. Once wounds have closed, managing post-inflammatory changes, such as hyperpigmentation, can be addressed with topical agents like hydroquinone or Vitamin C. For raised or indented scars and underlying sinus tracts, a dermatologist may recommend laser therapy to improve skin texture.
Advanced Medical Treatment Options
When home care and lifestyle changes are insufficient for controlling HS lesions, medical intervention is required. Mild cases are often treated with prescription topical therapies, such as a 1% clindamycin solution, to decrease inflammation and bacteria on the skin. For more widespread disease, oral antibiotics, including long-term combinations of rifampin and clindamycin, are frequently prescribed to address systemic inflammation.
Dermatologists also utilize procedural options. Corticosteroid injections, such as triamcinolone, can be administered directly into painful, early-stage nodules to reduce inflammation. For chronic, interconnected lesions, surgical procedures like deroofing involve removing the “roof” of the sinus tracts to expose them and allow them to heal from the base.
For moderate to severe HS that has not responded to other treatments, biologic medications are used. These drugs, such as adalimumab, target specific inflammatory pathways in the immune system to reduce disease activity. Consulting with a dermatologist is necessary for an accurate assessment of disease stage and to create a comprehensive treatment plan that may include these medications or procedures.