HS Treatment: How to Get Rid of Hidradenitis Suppurativa

Hidradenitis Suppurativa (HS) is a chronic skin condition causing painful nodules and abscesses, mainly in sweat gland areas. HS is estimated to affect between 1-4% of the global population. We look deeper into HS treatments, including antibiotics, hormonal therapies, biologic drugs, and surgical options, considering their effectiveness, side effects, and suitability for different HS stages and severities.

What is hidradenitis suppurativa (HS)?

Hidradenitis Suppurativa (HS), also known as acne inversa, is a long-lasting skin condition marked by painful boils that recur mainly in parts of the body with sweat glands. These boils can burst, leading to abscesses that release fluid and pus. While there's no current cure for HS, various treatments are available to control symptoms and prevent the formation of new boils and scars.

What is the best treatment for hidradenitis suppurativa?

People with hidradenitis suppurativa can choose from treatments ranging from home remedies to surgery, aimed at managing symptoms and minimizing complications.

Medications, which target inflammation, pain, and infections, are typically the first line of treatment. They need to be tailored to each person, as their effectiveness and side effects can vary. In severe cases, surgery may provide relief but has risks like scarring.

Lifestyle modifications, such as changing your diet and improving hygiene, are key to reducing flare-ups. For tough cases, seeing a dermatologist for treatments like laser therapy might be necessary.

The ultimate goal is managing symptoms effectively with as little disruption to daily life as possible, through a treatment plan customized for each individual.

Skin care plan

Developing a skin care plan is vital for managing HS and preventing its escalation. A gentle approach is key and might include the following treatments:

• Gentle antiperspirants: Ideal for sensitive skin, they help manage sweat without causing irritation. While effective in reducing moisture, it's important to monitor for any skin dryness or reactions, especially in delicate areas.
• Daily antiseptic wash: Using an antiseptic wash daily cleanses affected areas, reducing infection risk. These washes are generally well-tolerated, but can occasionally cause dryness or irritation, which should be monitored.
• Retinoids: These vitamin A derivatives aid in inflammation reduction and are effective in early to moderate stages of HS. Some people might notice skin irritation and increased sensitivity to sunlight, necessitating careful application and sun protection.
• Specific Body Washes: Formulated for sensitive skin, these can prevent irritation. Their effectiveness varies, and while generally safe, some may find certain formulas drying.

Topical medications

Topical treatments are often the first line of defense for early-stage HS, focusing on infection control and symptom relief. These include:

• Antibiotic creams (e.g., Aczone, Clindamycin): Effective in treating infected areas by targeting bacteria, they're best for early-stage HS to prevent worsening. Some skin dryness or minor irritation may be noticed in people with sensitive skin.
• Resorcinol: This chemical peel unclogs hair follicles and reduces inflammation, suitable for mild to moderate HS. It can cause skin peeling or irritation, which usually subsides with continued use.
• Lidocaine: Used for pain control, often in conjunction with ice packs, it's effective across various HS stages. Potential side effects include local skin numbness or, rarely, allergic reactions.

Steroid treatments

Steroids are often the next step in treating HS, where topical medications are proving ineffective. Generally administered via injection or oral tablet, there are two main groups of steroid treatment for HS:

• Steroid injections: Triamcinolone acetonide injections directly into sores can significantly reduce swelling and inflammation, offering relief for flare-ups. Adverse effects are usually minimal but can include local skin thinning or color changes.
• Corticosteroids: These steroids, either injected or taken orally, decrease inflammation quickly. While effective in controlling flare-ups, long-term use can lead to side effects such as weight gain, mood changes, and increased susceptibility to infection.

Hormonal management

Depending on the individual, it could be decided that hormones are a potential cause of the patient's HS. This is more common in women, and can be treated using medication which regulates and balances these hormones.

• Hormonal therapy: Treatments like estrogen-containing contraceptives and spironolactone target hormonal influences on HS, suitable for mild cases. Isotretinoin, primarily used for acne, may also benefit some HS patients. These options can have varied effectiveness and potential side effects like mood changes or, for isotretinoin, severe birth defects if used during pregnancy.
• Birth Control Pills: These regulate hormone levels, potentially reducing premenstrual HS flare-ups. The effectiveness and side effects, such as mood changes or increased blood clot risk, vary.

Advanced therapeutics

There are other, advanced therapies being used to treat HS. Many of these carry more severe risks and are therefore unlikely to be recommended without any of the previous treatment options being trialed first.

• Biologics: Targeting moderate to severe HS, biologics like adalimumab and infliximab modify the immune response to alleviate symptoms. They can be highly effective but carry risks of altering immune function, requiring careful monitoring.
• Adalimumab: Specifically for HS, this biologic therapy reduces inflammation by modulating the immune system, showing effectiveness in reducing symptoms with potential side effects including infections and allergic reactions.
• Retinoids: Oral retinoids, used for more acne-like forms of HS, help by reducing inflammation but are not suitable during pregnancy or breastfeeding due to high risk of birth defects.

Other medications

For those battling hidradenitis suppurativa (HS), a variety of other oral medications beyond topical treatments can offer relief and manage symptoms. Some options are:

• Oral antibiotics: While topical antibiotics help manage mild symptoms, oral antibiotics like doxycycline, clindamycin, and rifampin are prescribed for more severe cases. These medications can be effective in controlling infection and inflammation but may require prolonged use. Side effects can include gastrointestinal upset and, over time, antibiotic resistance.
• Pain medicine: For unmanageable pain, stronger prescribed medications may be necessary, focusing on pain relief when over-the-counter options are insufficient.
• Metformin: Used off-label, metformin can help by normalizing hormone levels and decreasing insulin resistance, offering an indirect benefit to HS symptoms with minimal side effects, primarily gastrointestinal issues.

Minimally invasive procedures

Minimally invasive procedures offer effective solutions for those with hidradenitis suppurativa (HS), especially in moderate to severe cases. These consist of the following:

• Unroofing: This localized surgical technique involves removing tissue to expose skin tunnels, providing a long-term solution for severe HS. While highly effective, patients should consider the potential for scarring and necessary recovery time.
• Punch debridement: A targeted approach for single inflamed bumps, punch debridement quickly addresses isolated sores with minimal side effects and recovery, making it suitable for spot treatment.
• Laser therapy: Utilizing carbon dioxide lasers, this method effectively eliminates HS sores, with a low risk of recurrence. Early-stage HS may benefit from laser hair removal to prevent lesion formation.
• Botox injections: By reducing excessive sweating, Botox can help prevent new HS lesions. The procedure is relatively simple, with side effects usually limited to temporary injection site discomfort.
• Incision and drainage: Though it provides quick pain relief, incision and drainage is less effective for long-term HS management due to the likelihood of recurrence. It's mainly used for immediate symptom relief in acute situations.

A strategic combination of these procedures with ongoing medical therapy can greatly enhance quality of life for HS patients. Each option comes with its own set of considerations, including effectiveness, potential side effects, and the individual's specific HS stage and symptoms.

Surgical care

Surgery is often essential for managing chronic hidradenitis suppurativa, especially for severe cases. Surgical strategies for HS aim to balance removing diseased tissue with minimizing unnecessary tissue loss. Surgical interventions include:

• Surgical removal: Targets persistent or severe HS by removing all affected skin. While effective, it may necessitate a skin graft for wound closure and does not prevent sores from developing in new areas.
• Wide excisions and STEEP procedure: Wide excisions remove the affected area as well as some healthy tissue for thorough treatment. The STEEP procedure (Skin-Tissue-sparing Excision with Electrosurgical Peeling) preserves more subcutaneous fat and the bottoms of sinus tracts, resulting in shallower defects and retaining more tissue integrity.

Surgical treatment for HS isn’t without risks. A case study on stage III vulvar HS showed potential complications like introital stricture when avoiding skin grafts. It is important that each HS patient is assessed individually, addressing and managing outcome expectations.

Home remedies and natural treatments

Natural treatments can play a supportive role in managing hidradenitis suppurativa (HS), offering relief from inflammation and discomfort during flare-ups. Some of the most common natural treatments are:

• Warm compresses: Applying a warm compress to affected areas can provide immediate pain relief, making it a simple yet effective remedy for HS discomfort.
• Turmeric: Known for its potent anti-inflammatory, antimicrobial, and antibacterial properties, turmeric can help reduce inflammation and prevent infections in HS lesions. It can be used both orally and topically, though individuals should be mindful of its potent nature and the potential for staining when used on the skin.
• Honey: Applying honey topically maximizes its antimicrobial, healing, and anti-inflammatory properties. It's particularly beneficial for soothing inflamed skin and promoting healing, suitable for direct application on HS areas.
• Aloe vera: This plant offers anti-inflammatory and antiseptic benefits, which may aid in managing HS symptoms. Its cooling effect can soothe the skin, making it a gentle option for topical use on sensitive or inflamed areas.
• Zinc: As a supplement, zinc helps reduce inflammation and swelling in the body. It's beneficial for overall immune function and skin health, making it a supportive dietary addition for those with HS.

These natural remedies can complement medical treatments for HS, providing additional relief and supporting skin health. However, it's important to discuss any new treatments with a healthcare provider, especially when considering supplements or applying new substances to the skin.

Do home remedies work for hidradenitis suppurativa?

Considering home remedies for HS can provide additional comfort and symptom relief. However, it's essential to note that these remedies do not cure HS but can complement your existing treatment plan.

A study published in the Journal of Drugs in Dermatology in October 2021 found that individuals using alternative therapies for HS reported an enhanced quality of life. This suggests that while home remedies are not a standalone solution, they can play a significant role in improving well-being alongside conventional treatments.

How to prevent hidradenitis suppurativa?

Preventing hidradenitis suppurativa (HS) involves lifestyle adjustments that can help reduce the risk of flare-ups and manage symptoms:

• Limit sweating: Try to stay indoors or in cooler environments during hot weather to minimize sweating, which can worsen HS symptoms.
• Weight management: If your BMI (Body Mass Index) is over 30, aiming for weight loss can significantly impact the severity and frequency of HS outbreaks. Reduced body weight lessens skin friction, a common trigger for HS.
• Choose unscented products: Scented deodorants and skin care products can irritate the skin. Opting for unscented or fragrance-free options can help prevent irritation and subsequent flare-ups.
• Quit smoking: Tobacco use can worsen HS symptoms. Quitting smoking not only improves HS but also benefits overall health. Healthcare providers can offer resources and support for those looking to quit.
• Wear loose clothing: Tight clothing can irritate and damage the skin, leading to flare-ups. Choosing loose-fitting garments allows the skin to breathe and reduces friction.

Implementing these preventive measures can make a significant difference in managing HS, reducing both the severity of symptoms and the likelihood of new flare-ups.

Clinical trials for hidradenitis suppurativa

Clinical trials play a pivotal role in advancing our understanding and treatment of hidradenitis suppurativa (HS). Given the complex nature of HS, where genetic, environmental, and hormonal factors intertwine, clinical research is crucial. These studies help to understand the causes of the condition and find new ways to treat it.

Recent years have brought a lot of new research into HS, leading to big improvements. Right now, Adalimumab is the only treatment for HS approved by the FDA, showing the need for more treatment options. Luckily, many new treatments are being tested in hidradenitis suppurativa clinical trials and are close to being approved.

HS research is actively looking into many different treatments like cytokine inhibitors, non-biologic medications, laser treatments, surgeries, and new ways to dress wounds.

With 17 therapeutic targets currently under investigation, the scope of research provides hope for more effective treatments on the horizon.

How to find a HS clinical trial

If you have hidradenitis suppurativa (HS) and are interested in participating in a clinical trial, here are some steps to get you started:

• Talk to your doctor: They may know of trials suited to your condition.
• Research online: Look for HS clinical trials on reputable medical research websites.
• Join HS support groups: These communities often share trial opportunities and advice.
• Reach out to research centers: Contacting institutions conducting HS research can yield direct trial information.
• Utilize search tools: Specific search platforms like ours, can help pinpoint trials based on your criteria.

Conclusion

Treating hidradenitis suppurativa (HS) effectively means using a mix of medical care, changing some lifestyle habits, and sometimes surgery. These options can help reduce symptoms and make daily life better for people with HS.

There's also exciting new treatments being researched through clinical trials. For example, Incyte Corporation is running a study on a new drug for people with moderate to severe HS. These trials are a big step towards finding better treatments for HS.

Overall, with the current treatments and promising research into new ones, there's a lot of options and positive progress for people living with HS.