Most medications for hidradenitis suppurativa focus on decreasing inflammation, and they can be applied to the skin, taken by mouth, or by injection (both locally or systemically). It can take weeks, sometimes months, for them to work. Topicals tend to work more slowly.
Topical Creams
Topical creams are used to diminish inflammation, pain, and to fight infection. They include:
Clindamycin (Cleocin T, Clindacin ETZ, Clindacin P) is a prescription antibiotic used to treat mild hidradenitis suppurativa. Applied to the skin, it reduces lumps and swollen areas beneath the skin, and treats infection on the skin’s surface. Side effects may include skin dryness, peeling, itching, burning, or redness.
Topical resorcinol is an over-the-counter chemical peeling agent that promotes skin exfoliation, prevents lesions from forming, and boosts wound healing. It can also decrease pain around lumps, but it typically takes three to four months for improvement. The cream may cause skin redness or peeling.
Biologics and Biosimilars
Biologics block specific parts of your immune system to decrease inflammation, and prevent and treat skin lesions. Three biologics have been approved by the U.S. Food and Drug Administration (FDA) to treat hidradenitis suppurativa:
Biologics are typically given through IV infusion or injection, and are currently the most effective medication available for people with moderate to severe hidradenitis suppurativa.
Biosimilar medications,which are similar to biologics, can cost up to 35 percent less than biologics. The FDA has approved biosimilars for adalimumab:
- adalimumab-ryvk (Simlandi)
- adalimumab-aaty (Yuflyma)
- adalimumab-aacf (Idacio)
- adalimumab-aqvh (Yusimry)
- adalimumab-fkjp (Hulio)
- adalimumab-afzb (Abrilada)
Because biologics and biosimilars change the way your immune system functions, they can put you at higher risk of infections and may cause side effects such as flu-like symptoms and headache.
Off-Label Oral Medications
Some medications for HS are called “off-label” because the FDA has not approved them specifically for HS. But they have been shown to improve symptoms.
Antibiotics
Your healthcare provider may prescribe oral antibiotics for hidradenitis suppurativa, which can lower inflammation and shrink lesions over a few months. Antibiotics can be used for mild, moderate, and sometimes severe symptoms. Some common antibiotics used for HS are:
- clindamycin (Cleocin HCl, Cleocin Phosphate, Cleocin Phosphate ADD-Vantage)
- rifampin (Rifadin, Rifadin IV, Rimactane)
- doxycycline (Vibramycin, Acticlate, Adoxa)
- minocycline (Minocin, Dynacin, Minocin, Minocin PAC, Minolira)
Side effects for clindamycin and rifampin are generally well-tolerated. While uncommon, minocycline can cause ear ringing, drowsiness, and muscle stiffness, and doxycycline can cause diarrhea and vaginal irritation, and sun sensitivity.
Corticosteroids
Corticosteroids can lower inflammation and pain associated with HS. The corticosteroid typically used in hidradenitis suppurativa are medium to high potency topical steroids. (Diprolene AF). So is the oral corticosteroid prednisone, typically prescribed in short-term bursts (three months or under) to avoid side effects like fluid buildup, high blood pressure, mood swings, and weight gain.
Hormonal Therapy
Hormones may play a role in hidradenitis suppurativa, with some reporting worsening symptoms just before menstruation and after pregnancy. Some hormone therapies are prescribed to treat HS, and have been shown to reduce inflammation, regulate androgen levels, and reduce flare-ups. These include:
These medications may come with a variety of side effects. If you notice any new symptoms after beginning a medication, let your healthcare provider know right away.
Other Treatment Options
Alternative treatment options for HS may be taken alongside other treatments under the direction of a healthcare provider. Zinc, one alternative treatment, is a nutritional supplement which may act as an anti-inflammatory, and research suggests it may help prevent and shorten HS flares. Zinc dosage varies by gender: between 8 and 12 milligrams (mg) per day. Higher dosages carry the risk of side effects like diarrhea, stomach cramps, and vomiting.
Retinoids, another option, affect how your skin cells grow and mature, and some small studies and anecdotal evidence suggests it may help diminish HS symptoms for some people. Some commonly prescribed retinoids are:
Oral retinoids can cause side effects to the skin like redness, itching, scaling, and dryness, and they should not be taken if you’re pregnant or intend to get pregnant.
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