If painful, recurring bumps in skin folds are ruining your days, you might be dealing with hidradenitis suppurativa (HS). Treatment won’t always cure it, but the right mix of medical care, self-help and sometimes surgery can cut flare-ups, ease pain, and speed healing. This page gives clear, usable steps you can discuss with your doctor.
Topical care is often the first move for mild HS. Your dermatologist may suggest topical antibiotics like clindamycin for small lesions. For more frequent or larger flare-ups, oral antibiotics such as doxycycline or minocycline can calm inflammation and control infection.
When antibiotics aren’t enough, doctors try other options. Hormonal therapies (birth control pills or spironolactone) help many people, especially if flares link to periods. For moderate-to-severe HS, biologic drugs that target inflammation—most commonly adalimumab—can reduce lesion count and pain. Intralesional steroid injections shrink painful nodules fast and are useful between longer-term treatments.
Surgery is an important tool, not a last-ditch shame move. For single stubborn tunnels or recurrent nodules, deroofing (removing the top layer of a tunnel) can give long symptom-free periods. Wide excision removes affected skin when disease is extensive. Simple drainage eases pain now but usually won’t prevent new lesions; your surgeon will explain pros and cons for your case.
Small daily changes make a big difference. Stop smoking if you can—smoking is linked to worse HS. Losing even modest weight often reduces friction and flare frequency. Wear loose, breathable clothing and avoid tight waistbands or straps that rub skin folds.
For wound care, keep areas clean with gentle soap, use warm compresses to reduce pain, and apply non-stick dressings to absorb drainage. Don’t squeeze or lance lesions yourself—this raises infection risk and scarring. Over-the-counter pain relievers help short-term; your clinician can suggest stronger options if needed.
Some people notice fewer flares when they cut back on high-glycemic foods or dairy, though responses vary. Track your diet and symptoms to spot personal triggers. Support groups and online forums can provide practical tips and emotional backup—HS can be isolating, and hearing real experiences helps.
When should you see a specialist? If lesions are painful, recurring, or forming tunnels and scarring, see a dermatologist. Ask about a coordinated plan that may include meds, injections, and minor surgery. Complex cases sometimes need a multidisciplinary team with surgeons, wound nurses, and sometimes endocrinologists.
HS treatment is rarely one-size-fits-all. Keep a log of flares, treatments, and triggers, and bring it to appointments. Good care aims to reduce flare frequency, control pain, and improve daily life. Talk openly with your provider about goals, side effects, and what to expect next.
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