Treatments for hidradenitis suppurativa

What are the treatments for hidradenitis suppurativa meant to do?

As there is no curative treatment, the treatments for hidradenitis suppurativa aim to clear or reduce the symptoms, to reduce the frequency and severity of flares and to improve quality of life [SFD].

The goals set by the Société Française de Dermatologie are [SFD]:

• to clear or reduce pain, abscesses and discharge of pus;
• to reduce the frequency and severity of flares;
• to improve quality of life.

Care is multidisciplinary, ideally within a dedicated multidisciplinary team meeting or a specialised network for severe forms [SFD]. Treatments are adapted to the severity of the disease [Pasteur], most often assessed with the Hurley stages.

According to the Institut Pasteur, complete remissions can be achieved, but they are followed by relapses when there is no maintenance treatment; a maintenance treatment seems to be needed in most patients with a moderate to severe form [Pasteur].

Which general measures are recommended?

Stopping smoking and losing weight are recommended in hidradenitis suppurativa [SFD].

Smoking and weight

Smoking is associated with the disease [14], and being overweight is associated with more severe disease [12]. The Société Française de Dermatologie recommends stopping smoking and reducing weight [SFD]. The Institut Pasteur also mentions keeping diabetes, if present, under control [Pasteur].

Diet

No particular diet can be recommended; a balanced diet is encouraged [SFD].

Friction

Repeated friction is one of the factors thought to play a part in the appearance of lesions [9], which can affect areas of friction such as the nape of the neck or the abdomen [sheet]. The sources for this page do not give a precise recommendation on this point: talk to your doctor about it.

Other conditions and current treatments

• Cardiovascular risk is assessed as in the general population, and a metabolic syndrome leads to a specialist opinion [SFD].
• The combined (oestrogen-progestogen) contraceptive pill is not recommended to treat the disease. If the flares follow the menstrual cycle or if polycystic ovary syndrome is suspected, a gynaecological or endocrinological opinion is advised [SFD].
• The Institut Pasteur mentions stopping anti-inflammatory medicines and medicines that lower immunity [Pasteur]. This decision is for your doctor to make: never stop a treatment on your own.

Which local care for hidradenitis suppurativa?

For washing, antiseptics do no better than soap and water, and suitable dressings improve quality of life when the lesions drain a lot [SFD].

• Washing: local antiseptics are no more effective than washing with soap and water [SFD].
• Dressings: when there is heavy discharge, dressings that are absorbent, non-irritating and reduce odour (adhesive only at the edges, foam or hydrofibre dressings) improve quality of life [SFD].
• Antibiotic creams or lotions: they are not recommended, because of insufficient evidence and the risk of bacterial resistance [SFD]. The Institut Pasteur also considers the effectiveness of local treatments to be modest [Pasteur].

How is the treatment chosen according to the stage?

The Société Française de Dermatologie proposes step-by-step care, according to the Hurley stage and the number of flares per year [SFD].

1. 1 Stage I with fewer than 4 flares per year: treatment of each flare (local care, a short course of antibiotics, incision of an abscess to relieve the pain), with no long-term treatment. If a lesion comes back in the same place, a limited excision may be offered.
2. 2 Stage I with at least 4 flares per year, or stage II: in addition, a long-term antibiotic to prevent flares, reassessed after 6 months. If this fails after 3 to 6 months at stage II, surgery (wide excision or deroofing) and specialised care are offered.
3. 3 Stage III: specialised multidisciplinary care, with an initial intensive course of antibiotics, then surgery and/or a long-term antibiotic and/or an immunomodulator, according to the team’s decision.

Two particular situations are described [SFD]: in the follicular form, retinoids and then anti-TNF medicines may be offered if treatment fails; when the disease is associated with an inflammatory bowel disease or inflammatory rheumatic disease, an anti-TNF medicine may be offered earlier.

Simplified summary of the decision tree of the Société Française de Dermatologie [SFD]. Your doctor adapts these steps to your case.

When are antibiotics used?

Antibiotics are used during flares, to prevent recurrences and before surgery [SFD].

Hidradenitis suppurativa should not be regarded as an infectious disease: bacteria are thought to play a part in the progression of the disease, but not to be its cause. In chronic lesions, they form a “biofilm”, resistant to antibiotics, which may explain the frequent relapses [sheet] [11].

• During a flare: a short course of an antibiotic taken by mouth, started at the first symptoms. The doctor can prescribe it in advance for later flares [SFD].
• To prevent flares: from 4 flares per year, a long-term antibiotic may be offered, then reassessed after 6 months [SFD].
• In severe forms: an initial intensive treatment lasting a few weeks, 21 days at most, before surgery and/or a long-term treatment [SFD].

The treatment is chosen without taking a sample, except in case of fever, which is unusual [SFD]. The Institut Pasteur describes the same principle: an initial intensive treatment, then a light long-term maintenance treatment [Pasteur].

Which biologics for hidradenitis suppurativa?

Biologics (biological medicines) are reserved for moderate to severe forms. In the guidelines of the Société Française de Dermatologie, these are the anti-TNF medicines: adalimumab and, by analogy, infliximab [SFD].

• Adalimumab has had a European marketing authorisation since 2015 for active, moderate to severe hidradenitis suppurativa in adults who have not responded well enough to the usual treatments [SFD]. It may be considered at stages II and III after antibiotics have failed, and stopped if it is not effective after 3 to 6 months. It is offered earlier when there is an associated inflammatory rheumatic disease or inflammatory bowel disease [SFD].
• Infliximab does not have a marketing authorisation for this disease. It is offered by analogy, only by expert teams, with a reassessment at 3 to 6 months [SFD].

Reimbursement in France: at the date of these guidelines, adalimumab was not reimbursed for this indication, as the Haute Autorité de santé (HAS, the French National Authority for Health) had judged in 2016 that its medical benefit was insufficient [SFD]. This situation may have changed since then: your dermatologist will be able to tell you.

What about more recent biologics?

The Institut Pasteur lists adalimumab and secukinumab among the biological immunomodulators for moderate to severe forms, which reduce flares by 50% in 50% of patients [Pasteur].

The guidelines of the Société Française de Dermatologie date from 2019 and do not cover more recent biologics. Other medicines, such as bimekizumab, are not covered by the sources for this page. Your dermatologist will be able to tell you which treatments are available today.

Which other treatments may be offered?

Other treatments are sometimes used, but the evidence for their effectiveness is limited [SFD].

• Retinoids: the evidence is insufficient to recommend them in general, but they may be used in the follicular form [SFD].
• Corticosteroids (injected into a lesion or given by mouth or injection to act on the whole body), dapsone and ciclosporin: the evidence is insufficient to recommend them. Injections into lesions carry a risk of thinning of the skin [SFD].
• Lasers: the Nd:YAG hair-removal laser may be offered to prevent lesions. Destroying lesions with a CO2 laser does not seem to do better than surgery [SFD].

When is surgery offered?

Surgery ranges from emergency incision of an abscess to wide excision of the affected areas. It is always decided jointly by the dermatologist and the surgeon [SFD].

1. 1 Incision and drainage of an abscess, as an emergency, relieve the pain immediately. This procedure is not a permanent solution: recurrences are very common [SFD].
2. 2 Deroofing (“mise à plat” in French) consists of removing the roof of a tunnel while sparing the healthy skin; the wound heals by itself. It is offered for a nodule that persists or for limited tunnels, most often under local anaesthesia. Recurrences are estimated at between 20 and 50% [SFD].
3. 3 Limited excision completely removes a localised lesion, most often under local anaesthesia. Recurrences are estimated at between 40 and 70% [SFD].
4. 4 Wide excision, under general anaesthesia, removes the whole affected area with a margin of healthy skin, at stages II and III. The wound closes by itself, with a skin graft or with a skin flap. This is the technique with the fewest recurrences in the operated area (0 to 15%), but it requires prolonged care after the operation and can leave scars that pull, which physiotherapy helps to prevent [SFD].

For the Institut Pasteur, surgery is effective only when combined with medical treatments, before and after the operation [Pasteur].

How are pain and the psychological impact managed?

Pain is treated according to the usual rules of pain management, and the psychological impact must be assessed by the doctor [SFD].

Pain

There is not enough evidence to recommend a specific strategy against pain in hidradenitis suppurativa. The doctor relies on the steps of the World Health Organization pain ladder, taking into account the type of pain [SFD]. Anti-inflammatory medicines (NSAIDs and corticosteroids) are not recommended for pain, because of the risk of infectious complications [SFD]. Incision of an abscess relieves the pain immediately (see surgery).

Mood and daily life

The disease affects relationships, intimate life, working life and mood, with a risk of depression [SFD]. Doctors must assess this impact, and a specialist opinion, psychological or psychiatric, may be needed [SFD]. The Institut Pasteur also mentions psychological support as part of overall care [Pasteur].

Where to seek care?

The treatment is decided with your general practitioner or a dermatologist, who can refer you to a specialised team.

The Seeing a doctor page explains which doctor to see and how to find a dermatologist. For the signs of the disease, see also Symptoms and diagnosis.

What are the sources for this page?

The information on this page comes mainly from the guidelines of the Société Française de Dermatologie, supplemented by the Institut Pasteur disease fact sheet, the SNFCP summary sheet and the studies it cites.

[SFD] Société Française de Dermatologie, Centre de Preuves en Dermatologie. Recommandations hidradénite suppurée (hidradenitis suppurativa guidelines, 2019 update): management decision tree and pages “Objectifs du traitement”, “Alimentation et tabac”, “Hygiène”, “Mesures associées”, “Contraception”, “Comorbidités”, “Retentissement psychologique”, “Antibiotiques”, “Anti-TNF”, “Rétinoïdes”, “Immunomodulateurs”, “Lasers” and “Chirurgie” (pages updated between 2024 and January 2026).

[Pasteur] Institut Pasteur. Maladie de Verneuil : symptômes, traitement, prévention. Disease fact sheet, updated in January 2026. Read the fact sheet on pasteur.fr

[sheet] Ezanno AC, Fougerousse AC, Alam A. Maladie de Verneuil – Épidémiologie. Diplôme inter-universitaire de proctologie médicochirurgicale, SNFCP, 2024.

Studies cited by the summary sheet and used on this page, with their original number:

9. Melnik BC, Plewig G. Impaired Notch-MKP-1 signalling in hidradenitis suppurativa: an approach to pathogenesis by evidence from translational biology. Exp Dermatol. 2013 Mar;22(3):172–7. Search on PubMed
11. Ring HC, Bay L, Nilsson M, Kallenbach K, Miller IM, Saunte DM, et al. Bacterial biofilm in chronic lesions of hidradenitis suppurativa. Br J Dermatol. 2017 Apr;176(4):993–1000. Search on PubMed
12. Bettoli V, Naldi L, Cazzaniga S, Zauli S, Atzori L, Borghi A, et al. Overweight, diabetes and disease duration influence clinical severity in hidradenitis suppurativa-acne inversa: evidence from the national Italian registry. Br J Dermatol. 2016 Jan;174(1):195–7. Search on PubMed
14. Revuz JE, Canoui-Poitrine F, Wolkenstein P, Viallette C, Gabison G, Pouget F, et al. Prevalence and factors associated with hidradenitis suppurativa: results from two case-control studies. J Am Acad Dermatol. 2008 Oct;59(4):596–601. Search on PubMed