8th June 2025

Management

Management depends on the severity of disease and impact on quality of life. Treatment is split into general advice, medical and surgical treatment. The main aim is to reduce new and existing lesions, sinus tracts and scarring. However, there is a lack of curative treatment.

General advice

• Good hygiene – antiseptic cleansers are often recommended
• Antiperspirants
• Loose-fitting cotton clothing
• Avoid shaving affected areas
• Minimise heat, humidity, sweating, trauma, friction and irritation 
• Weight reduction if overweight or obese 
• Smoking cessation

Medical treatment (high-quality evidence is limited)

• Intralesional corticosteroid
  • Sometimes used for acute, painful lesions
• Antibiotics
  • Topical
    • For mild disease
    • Clindamycin lotion
  • Systemic
    • Lymecycline, doxycycline or macrolide, usually used for prolonged durations such as 3-6 months
    • Clindamycin and rifampicin, usually for 10-12 weeks
• Biological therapies
  • For moderate to severe, refractory HS
    • Anti-TNF (adalimumab or infliximab)
    • Anti-interleukin-17A (secukinumab)
• Anti-androgens (for women)
  • Combined oral contraceptive pill
  • Spironolactone
• Dapsone
• Metformin
• Retinoid (acitretin – unsuitable for women of child-bearing potential)

Surgical treatment 

• Deroofing of sinus tracts
• Localised excision of discrete chronic lesions
• En bloc resection of an entire zone (e.g. axilla – for severe disease)

Prognosis

• Natural history is variable but often there is gradual worsening
• Treatment aims to control symptoms and reduce progression of disease 
• High recurrence rate of disease despite treatment