Dermatologists are trained in the treatment of HS, and can discuss the range of treatment options available, along with why you may or may not want to consider a given treatment. They can also discuss how the condition can progress over time, and why and when HS may require surgery. While you most likely won’t need to make more than a handful of decisions about your HS treatment at a given time, it can’t hurt to look ahead to what your treatment may look like in the future. Here are some questions to consider asking your doctor if you’re newly diagnosed with HS, or simply want to know more about your options.
1. What treatment options are available for HS?
A wide range of treatment options for HS are available, from topical washes and creams, to oral and infused drugs, to surgical procedures, explains Oma N. Agbai, MD, a dermatologist at UC Davis Health in California. One of the main treatments for HS is antibiotics, says Dr. Agbai, since these drugs can help reduce inflammation in the skin and prevent infection. “HS is not necessarily a problem with infection in the skin. It’s a problem with inflammation,” she notes, but bacteria may contribute to the immune system’s overreaction in the disease. Other treatments may include skin washes like those for acne, some containing benzoyl peroxide, or topical antibacterial washes. Your dermatologist may even discuss what’s known as a bleach bath, and can advise you on how to do this procedure at home safely to reduce bacteria on the skin. If your HS progresses to a more severe stage or if it’s already advanced at the time of diagnosis, your doctor can discuss other drug options, such as corticosteroids, oral retinoids, or biologics. Surgical procedures may also be an option for severe cases of HS.
2. How does the severity of HS affect treatment options?
HS can be broadly categorized as mild, moderate, or severe, and each stage of the disease has a range of recommended treatment options. In mild disease, “You have potentially one abscess or nodule that comes and goes,” while in severe disease, you’re likely to have “multiple interconnected tracts that cause drainage” of fluids, Agbai notes. Topical treatments are often used for mild disease, says Benjamin Kaffenberger, MD, a dermatologist at the Ohio State University Wexner Medical Center in Columbus — possibly with occasional injections of steroids in areas of disease activity. But “as you get into moderate to severe disease, at least for inflamed and active areas, patients need oral and sometimes even IV antibiotics,” he adds. For severe disease characterized by large areas of inflamed or damaged skin, it’s common to consider biologic therapies — drugs that block a specific pathway in your immune system that can lead to inflammation. These drugs are administered by infusion or injection. While only one biologic drug, adalimumab, is approved for HS by the U.S. Food and Drug Administration (FDA), doctors may also consider using other drugs in this family.
3. What are the goals of treatment for HS?
The main goal of HS treatment is “to decrease the inflammation that’s present: the redness, the pain,” says Dr. Kaffenberger. “But that doesn’t help the people [who] have tunnels underneath the skin that are constantly draining and leaking and getting plugged up,” so dealing with this drainage is another major concern. In addition to addressing overall pain and fluid drainage from HS, “We’re looking to see how this is affecting other aspects of their life — interrupted sleep, interrupted work, things like that,” Agbai notes. If HS is affecting a particular aspect of your life, you and your doctor may discuss treatment options in that specific area — such as addressing ways to sleep better — or a general change or step up in your treatment plan. And since HS can progress from mild to moderate or severe, “the goal, when a patient is presenting with mild disease, is to treat them medically so that they never progress to the point where they potentially need surgery,” Agbai emphasizes.
4. What are some signs that I may need to adjust my treatment plan for HS?
You and your doctor can discuss changing your HS treatment plan whenever you’re experiencing active disease or painful or bothersome symptoms. “If it looks like the patient is still having a lot of pain or drainage, then we move on to talking about other treatment options,” says Agbai. When it comes to changing treatments, “The major factors are what a patient has been on in the past, whether they responded to those treatments, and how severe the disease is,” says Kaffenberger. In mild HS, you may want to discuss changing your treatment if you experience any recurring symptoms that cause you discomfort. In moderate to severe disease, a change may be in order if you continue to experience large areas of painful, inflamed skin, or if damaged skin leads to persistent drainage of fluid from the area.
5. When is surgery an option for HS?
Surgery may sound like a scary or drastic option for HS, but it actually refers to a wide range of procedures — from draining a single inflamed nodule to removing large areas of damaged skin. “When it’s mild, performing an excision of a nodule that keeps coming back” is sometimes an option, says Agbai, even though this may not help limit the development of other nodules or areas of inflammation. But usually, surgery is performed for HS “to address damage that has already been done,” Agbai notes, meaning that the structure of the skin has changed due to past inflammation and scarring. This disfigured skin “often has tunnels that will not go away with medical treatment. They just keep filling up and draining,” she explains. Surgery to cut these large HS lesions out of the skin can leave deep wounds that may need to be covered with a skin graft or flap, according to the American Academy of Dermatology. “When you remove a large section of skin, it becomes very tight, and these are areas where there is always friction, ”adds Kaffenberger.
6. Are there home or alternative remedies to consider for HS?
Self-care practices can have an effect on HS symptoms, with obesity and smoking being the two most prominent risk factors for the condition. “If the patient is able to lose weight, if they are obese, that can sometimes lead to a dramatic improvement in the patient’s HS,” says Agbai. “It can even lead to clearing of the skin.” If you smoke, your doctor may discuss smoking cessation options with you. Other self-care tips include avoiding shaving affected areas of skin during a breakout, as it can make a flare of HS worse, and not wearing tight or irritating clothing that causes discomfort in an area of disease. Agbai notes that some people with HS find dietary changes helpful in reducing their symptoms, although the scientific evidence to back this up is weak at the moment. Still, she says, “I encourage patients to avoid sweets, and try to focus on what’s called a Mediterranean diet,” emphasizing vegetables and fruits, lean meats, and nuts and seeds. For many patients, Agbai also recommends taking a zinc supplement, which “has been shown to help promote healing and decrease inflammation in the skin of people with HS,” she notes. But it’s important to discuss the risks and dosing of such a supplement with your dermatologist. When it comes to any question you might have about HS treatment, “It’s very important to communicate with all of your doctors,” Agbai emphasizes. “We want to know if the treatments are working.”
