Managing hidradenitis suppurativa (HS) is possible. With the right treatment and self-care, you can reduce flares, ease pain, and improve your quality of life.

Hidradenitis suppurativa (HS) is a chronic skin condition that causes painful bumps, tunnels, and scars, often in areas where skin rubs together, like the armpits, groin, buttocks, and under the breasts.

It’s not caused by poor hygiene or an infection. While there’s no cure, several treatments and lifestyle changes can help manage hidradenitis suppurativa, reduce flare-ups, ease pain, and improve quality of life.

Symptoms of HS can vary from person to person and may change over time.

Common signs include:

  • painful lumps under the skin
  • nodules or boil-like sores that may drain or leak
  • blackhead-like spots with two openings (“tombstone” comedones)
  • tunnels under the skin that connect lumps (sinus tracts)
  • scarring or changes in skin color in affected areas

Managing hidradenitis suppurativa often combines medical treatments, surgery, and lifestyle changes to reduce symptoms, prevent flare-ups, and improve quality of life.

Medical management approaches

  • Topical treatments: For mild HS, doctors often prescribe clindamycin 1% solution or gel (Cleocin T) twice daily, antiseptic washes like chlorhexidine (Hibiclens) or benzoyl peroxide, or keratolytics such as resorcinol 15% cream to open clogged hair follicles.
  • Systemic antibiotics: For moderate HS, these reduce inflammation and also control certain bacteria on the skin that may contribute to HS.
  • Options include:
    • doxycycline (Vibramycin) or minocycline (Minocin) for about 12 weeks
    • clindamycin (Cleocin) with rifampin (Rifadin) for 10 to 12 weeks in more severe cases
    • triple therapy with rifampin, moxifloxacin (Avelox), and metronidazole (Flagyl) for resistant HS
    • dapsone for lesions(sores) that do not improve with other antibiotics
  • Hormonal therapies: Treatment may involve one or more of the following: spironolactone (Aldactone), finasteride (Propecia, Proscar), combined oral contraceptives, or metformin (Glucophage), which may help people with PCOS, hormonal triggers, or insulin resistance.
  • Retinoids: Made from vitamin A, retinoids help prevent clogged hair follicles and reduce inflammation. Doctors may prescribe acitretin (Soriatane), a medication sometimes used for psoriasis, or isotretinoin (Accutane) when HS overlaps with severe acne. You cannot take these medications during pregnancy, as they can harm a developing fetus.
  • Biologics and advanced therapies: For moderate to severe HS that doesn’t respond to other treatments, FDA-approved options include adalimumab (Humira), secukinumab (Cosentyx), and bimekizumab (Bimzelx). Emerging therapies include JAK inhibitors such as upadacitinib and povrocitinib, as well as IL-1 and IL-23 inhibitors.

Surgical and procedural interventions

For severe or treatment-resistant HS, surgery can help halt disease progression and improve quality of life. These include:

  • ​​Minor procedures: Used to relieve pain or remove smaller affected areas. They include incision and drainage for acute pain (though recurrence is common), deroofing to remove the skin covering a tunnel while sparing surrounding tissue, and punch debridement to remove small affected sores.
  • Major surgical options: For extensive HS, these include wide excisions to remove large areas of affected skin (sometimes with reconstruction), staged excisions to treat different areas in phases, and the STEEP technique, which uses electrosurgery to remove diseased skin while sparing healthy tissue.
  • Laser and light therapies: These include the Nd:YAG laser to target hair follicles and reduce recurrence, the CO₂ laser to remove or vaporize affected tissue, and photodynamic therapy, which combines light with a photosensitizing agent, though evidence for using photodynamic therapy for HS is limited.

Lifestyle and supportive measures

A 2025 study found that making certain lifestyle changes can reduce HS flare-ups and discomfort, especially when combined with medical or surgical treatments.

  • Dietary considerations: A 2022 study suggests weight loss and anti-inflammatory diets, such as the Mediterranean diet, may reduce HS flares. Limiting foods like dairy and brewer’s yeast may also help, though evidence is limited.
  • Smoking cessation: Smoking is linked to more frequent and severe HS flares. Quitting can help reduce symptoms and improve treatment outcomes.
  • Clothing and friction reduction: Wearing loose, breathable, seamless clothing and moisture-wicking fabrics reduces skin irritation in areas where skin rubs together.
  • Pain management: NSAIDs and topical analgesics can relieve discomfort. Combining treatments, like medications, cognitive behavioral therapy (CBT), and lifestyle changes, can help manage chronic pain more effectively.
  • Wound care: Using absorbent dressings, antimicrobial barriers, and friction-reducing methods can help manage drainage, protect skin, and support healing.

Living with HS can affect mental well-being. A 2023 study review found that depression and anxiety affect about 20_30% of people with HS.

Here are ways to find support:

  • Therapy or counseling: A mental health professional can help with body image concerns, stress, and relationship issues.
  • Peer support groups: Connecting with others living with HS can reduce isolation and provide practical tips on clothing, flare triggers, and wound care.
  • Patient advocacy groups: Organizations like HS Foundation and Hope for HS offer education, treatment updates, and tools to help you prepare for doctor visits.

If HS is affecting your mental health, talk with your doctor. They can refer you to a mental health professional to help you cope and support your emotional well-being.

Research into HS is growing, offering hope for better treatments. Emerging studies are exploring the skin and gut microbiome, genetic profiling to identify those at risk, and new targeted therapies to reduce inflammation more accurately.

Clinical trials are investigating medications such as JAK inhibitors, IL-1 and IL-23 blockers, and other biologics that are not yet widely available.

If you’re interested in joining a clinical trial, you can ask your dermatologist or search databases such as ClinicalTrials.gov. Participation can give access to new treatments and help researchers learn more about HS.

Managing hidradenitis suppurativa works best with a multidisciplinary approach. Your care team may include a dermatologist, surgeon, pain specialist, mental health professional, and, when needed, a gynecologist or urologist.

A personalized plan often uses a step-up approach, starting with milder treatments and moving to advanced options if needed. Work with your care team to track symptoms, note flare triggers, and adjust strategies, while setting realistic goals to help measure progress over time.

The outlook can vary by disease severity, but several treatments, including biologics like adalimumab, have improved outcomes for many. Experts are also testing new therapies, offering hope for even more effective options in the future.

HS is chronic and currently has no cure. Many people can manage symptoms, reduce flare-ups, and prevent complications with early diagnosis, a personalized treatment plan, and lifestyle changes such as quitting smoking and maintaining a healthy weight.

No, hidradenitis suppurativa is not contagious. It isn’t caused by an infection, and it can’t spread from person to person.

HS often occurs in areas where skin touches or rubs together, commonly the armpits and groin, and can form tunnels. Acne and boils are usually more superficial and do not form tunnels.

Yes, HS can go into remission with proper treatment and lifestyle changes, but flares may still recur because it is a chronic condition.

Yes, some dietary changes, such as a Mediterranean diet, may help improve symptoms, but no specific diet is currently recommended for managing hidradenitis suppurativa.

Managing hidradenitis suppurativa takes a combination of medical treatments, lifestyle changes, and emotional support. While there’s no cure, the right treatment plan can help manage flares, reduce pain, and improve quality of life.