HS care refers to the ongoing management of hidradenitis suppurativa, a chronic inflammatory skin condition that causes painful nodules, abscesses, and tunnels beneath the skin. Because HS has no cure, care focuses on reducing flares, managing pain, treating wounds, and preventing the disease from progressing. The approach combines medications, wound management, lifestyle changes, and sometimes surgery, tailored to how severe your disease is.
What Hidradenitis Suppurativa Actually Is
HS starts when a hair follicle becomes blocked and ruptures, releasing keratin and bacteria into the surrounding skin. This triggers an intense immune response: white blood cells flood the area, forming abscesses and destroying the follicle along with nearby tissue. Over time, this cycle of blockage, rupture, and inflammation can create tunnels (called sinus tracts) under the skin that connect multiple lesions, along with thick scarring.
The lesions typically appear in skin folds: armpits, groin, under the breasts, between the buttocks. They range from 0.5 to 2 cm and can persist for days to months. Some drain fluid or blood. The disease tends to cycle between flares and quieter periods, but without treatment, it often worsens over time.
How Severity Shapes Your Treatment Plan
Doctors use the Hurley staging system to classify HS into three levels, and your stage largely determines what kind of care you receive.
- Hurley Stage I: One or more abscesses without sinus tracts or scarring. Treatment is primarily medication-based.
- Hurley Stage II: Recurrent abscesses with some sinus tracts and scarring, separated by patches of normal skin. Treatment combines medication with targeted surgical procedures.
- Hurley Stage III: Widespread, interconnected abscesses and sinus tracts covering an entire area. Treatment involves both medication and more extensive surgery.
Topical and Oral Medications
For mild to moderate HS (Hurley stages I and II), a topical antibiotic applied directly to lesions is typically the first step. This is usually applied twice daily for about 12 weeks. Some patients respond to a topical peeling agent applied once daily instead, which helps open clogged follicles and reduce inflammation on the surface.
When topical treatments aren’t enough, oral antibiotics may be added. These aren’t just fighting infection; at certain doses, they also help calm the inflammatory process driving HS. Your doctor may try different combinations or durations depending on how you respond.
Biologic Therapies for Moderate to Severe HS
For people with Hurley stage II or III disease who haven’t responded to antibiotics, biologic medications represent the most significant treatment advance in HS care. Three biologics currently have FDA approval specifically for HS. The first targets a protein called TNF-alpha that drives inflammation. Two newer options target a different inflammatory protein called IL-17, approaching the disease from another angle.
These medications are given by injection, either at home or in a clinic, and they work by dialing down the specific immune pathways that fuel HS. They don’t work overnight. Clinical trials measured improvement over weeks to months, and staying on the medication long-term is generally necessary to maintain results. Not everyone responds to the first biologic they try, so switching between them is common.
Managing HS Pain
Pain is one of the most disruptive parts of living with HS, and it comes in two forms. Acute pain hits during flares when abscesses are inflamed or about to rupture. Chronic pain lingers between flares, sometimes as a deep ache from tissue damage (nociceptive pain) and sometimes as a burning sensation from nerve involvement (neuropathic pain). Recognizing which type you’re dealing with helps guide treatment.
For mild acute pain, over-the-counter options like acetaminophen or topical anti-inflammatory gels can help. If pain persists, oral anti-inflammatories like ibuprofen or naproxen are the next step. A doctor can also inject a steroid directly into an inflamed lesion for rapid relief. Numbing creams or patches applied to intact skin around painful areas offer additional comfort, especially before dressing changes.
Chronic HS pain often requires a broader approach. Physical therapy, consistent wound care, and mental health support all play roles. For persistent nociceptive pain, anti-inflammatory medications remain useful. For neuropathic pain (that burning quality), certain antidepressants that also modulate pain signals can be effective. Pain specialists may become part of your care team if pain becomes difficult to control.
Daily Wound Care
Draining lesions and post-surgical wounds are a daily reality for many people with HS, making wound care a core part of the routine. The goals are simple: absorb drainage, protect inflamed skin, and avoid adhesives that tear fragile tissue.
Abdominal pads (ABD pads) made of wicking material work well for heavy drainage and are affordable. Feminine hygiene pads, designed to absorb large amounts of fluid, are another practical option that works for anyone regardless of gender. Reusable flannel pads offer a breathable, gentle alternative. For securing dressings in tricky spots like the armpits or groin, specialized garments designed for HS patients can hold pads in place without tape.
When you do need an adhesive dressing, island dressings (bordered gauze with a non-stick center) or silicone-bordered foam dressings are gentler options. If even silicone adhesive irritates your skin, placing a non-adhesive oil emulsion gauze directly against the wound first, then covering it with foam, keeps adhesive away from raw tissue entirely. Look for hypoallergenic, cotton-based products whenever possible.
Surgical Options
Surgery becomes part of HS care when medications alone can’t control the disease, particularly for recurring abscesses and established sinus tracts.
Deroofing is a minimally invasive procedure used for stage II and III lesions. The surgeon removes the “roof” of abscesses and sinus tracts, exposing the floor underneath. The preserved base of the wound contains enough cells to regrow skin on its own, healing from the bottom up over several weeks. It can be done with a scalpel, laser, or electrosurgery probe, and recovery is relatively quick compared to more extensive operations.
Wide excision removes the entire affected area, including all diseased tissue and a margin of surrounding skin. This is typically reserved for severe, widespread disease. Recovery takes longer, wounds are larger, and there’s greater risk of complications. The tradeoff is a lower recurrence rate, especially when combined with ongoing medication and lifestyle changes after surgery. Some patients need skin grafts or flaps to close larger wounds.
Incision and drainage of individual abscesses provides fast relief during acute flares but has a high recurrence rate since it doesn’t address the underlying sinus tracts. It’s best thought of as a short-term measure rather than a definitive treatment.
Diet and Lifestyle Changes
Certain dietary changes show promise for reducing HS flares. In one study, 83% of 47 patients on a dairy-free diet experienced clinical improvement. When HS patients were surveyed about foods that triggered flares, the top culprits were sweets (68%), bread and pasta (51%), and dairy (51%). A low-carbohydrate, low-dairy approach has shown improvement in disease severity in smaller studies.
Brewer’s yeast is another notable trigger. Among patients who followed a yeast-free diet for 12 months after surgery, symptoms stabilized and lesions regressed. When they consumed brewer’s yeast products (beer is a common source), symptoms returned. In a separate group of 37 patients on a yeast exclusion diet, 70% reported improvement, and 87% of those who resumed eating yeast saw lesions return within a week.
Smoking and weight both influence HS significantly. Continuing to smoke raises the risk of HS by about 24%, and increasing cigarette consumption pushes that to nearly 29%. Obesity is roughly 3.5 times more common among HS patients than the general population, and higher BMI is associated with more severe disease. Weight loss and smoking cessation won’t cure HS, but they reduce the inflammatory burden that drives it.
The Emotional Side of HS Care
HS affects far more than skin. The pain, drainage, odor, and visible scarring create a cycle of embarrassment and self-consciousness that significantly erodes quality of life. Many patients withdraw from social situations, intimate relationships, and physical activities. The psychological burden is substantial, with high rates of depression and anxiety in this population.
Psychological support is increasingly recognized as a core part of HS care, not an afterthought. Therapy can help with acceptance of a chronic condition, coping strategies for flare-related distress, and the social isolation that often accompanies visible or intimate-area disease. Online communities and HS-specific support groups also provide connection with others who understand the daily realities of managing this condition.