Hidradenitis suppurativa: Diagnosis and treatment

A dermatologist is often the doctor who diagnoses a patient with hidradenitis suppurativa

Getting an accurate diagnosis and an individualized treatment plan can help prevent this condition from worsening.

How do dermatologists diagnose hidradenitis suppurativa?

Hidradenitis suppurativa can look like other skin conditions, including acne, boils, or herpes. Dermatologists have the training needed to spot the differences between these conditions. This unique training allows them to diagnose hidradenitis suppurativa.

If your dermatologist suspects that you may have hidradenitis suppurativa, here’s what typically happens. Your dermatologist will:

• Ask where you have lumps, drainage, and pain or other symptoms. Hidradenitis suppurativa tends to develop in certain areas, like the armpits, groin, buttocks, or under the breasts.

• Examine the lumps and sores. Hidradenitis suppurativa has certain features, which to the trained eye distinguish it from acne, boils, and other conditions.

• Talk with you about what they see on your skin. During this talk, your dermatologist will ask about your symptoms, when you first noticed the bumps and sores, if you have any other medical conditions, and about other specifics. This information helps your dermatologist give you an accurate diagnosis.

If you have a sore that’s leaking fluid, your dermatologist may swab a bit of the fluid so that it can be tested. This test can tell your dermatologist whether you have an infection.

If you have hidradenitis suppurativa, your dermatologist will create a treatment plan tailored to your needs.

How do dermatologists treat hidradenitis suppurativa?

While this condition cannot be cured, your dermatologist will create a treatment plan that can:

• Reduce flare-ups

• Heal wounds

• Relieve pain and itch

• Prevent the condition from worsening

• Allow you to participate comfortably in regular activities, such as walking and exercise

When creating a treatment plan, your dermatologist considers the types of bumps and sores you have, whether you have pain or an infection, and how the condition is affecting your life. This allows your dermatologist to customize a treatment plan for your specific needs.

Your treatment plan may include one or more of the following:

Skin care

Some soaps and other skin care products may irritate skin with hidradenitis suppurativa. To reduce irritation, your dermatologist can create a skin care plan for you. This plan may include using an antibacterial wash and switching to a gentle antiperspirant.

Medication you apply to your skin

If you have hard lumps beneath your skin, including lumps that may contain pus, your dermatologist may prescribe one or more of the following:

Antibiotic: A topical (applied to the skin) antibiotic called clindamycin is often prescribed to treat mild hidradenitis suppurativa. This medication can reduce lumps, including lumps that contain pus, and pus-filled swollen areas beneath your skin.

Apply this medication exactly as prescribed.

• Brand names: Cleocin T, Clindacin ETZ, Clindacin P, Clindacin Pac, Clinda-Derm, Clindagel, ClindaMax, ClindaReach, Clindets, Evoclin, Z-Clinz

Resorcinol cream: When used to treat hidradenitis suppurativa, this cream has been shown to decrease pain, swollen areas that contain pus, and the lumps beneath the skin. It takes about 3 to 4 months to see the effects. For this medication to be effective, you may need to continue using it after you see clearing.

If your skin becomes dry, scaly, itchy, or irritated after using resorcinol, tell your dermatologist.

Ruxolitinib cream: Hidradenitis suppurativa is an inflammatory skin condition. This prescription cream can calm the inflammation.

In one study, the patients who applied this cream had a 79% decrease in abscess and nodules and no new tunnels under their skin after applying the cream for 16 weeks. All patients had mild to moderate hidradenitis suppurativa.

Developing a cold was a common side effect in this study.

• Brand name: Opzelura

Medication that works throughout the body

When stronger treatment is needed, your dermatologist may prescribe:

Antibiotic: Oral (taken by mouth) or injectable: While hidradenitis suppurativa is not an infection, antibiotics are frequently prescribed to treat this condition. An antibiotic can reduce inflammation and bacteria that cause flare-ups on your skin.

Antibiotics prescribed to treat hidradenitis suppurativa often come in pill form. Some patients take one antibiotic pill once or twice a day. Other patients need to take two different kinds of antibiotics to control their skin condition. 

One antibiotic is given as an injection. Some patients can give themselves these injections at home.

Be sure to follow your dermatologist’s directions when taking (or injecting) an antibiotic. This may include wearing sun-protective clothing and sunscreen (broad-spectrum protection and an SPF of 30 or higher) while outdoors. Some antibiotics can make your skin sensitive to the sun.

Hormonal therapy: For some women, a medication called spironolactone may reduce hidradenitis suppurativa. Spironolactone can also reduce inflammation, which can reduce the lesions you see on your skin.

This medication works by blocking certain hormones, which is why it’s classified as a hormonal treatment.

In small studies of women, spironolactone has proven to be an effective treatment for hidradenitis suppurativa. In one such study, 85% of the women saw a reduction in lesions, with 55% seeing complete clearing of their hidradenitis suppurativa.

Spironolactone can cause birth defects. You should not take this medication while pregnant. Stop taking spironolactone if you find out that you are pregnant or decide that you want to become pregnant.

Other possible side effects include nausea, dizziness, irregular periods, and breast tenderness.

• Brand name: Aldactone (spironolactone)

Biologics and biosimilars: Studies show that some biologics can effectively treat hidradenitis suppurativa. Biologics work on part of your immune system, and the biologics used to treat hidradenitis suppurativa are designed to reduce inflammation.

A biosimilar is a type of medication that’s very similar to one specific biologic medication like adalimumab (Humira) or secukinumab (Cosentyx). However, the cost of a biosimilar may be much less than the cost of a biologic.

For more information, go to Biosimilars: 14 questions that patients ask their dermatologist.

If a biologic or biosimilar is a treatment option for you, your dermatologist may prescribe one of the following:

• Adalimumab: The U.S. Food and Drug Administration (FDA) has approved the biologic adalimumab (Humira) to treat moderate-to-severe hidradenitis suppurativa in patients 12 years of age and older. The FDA has approved other brands of adalimumab to treat adults with moderate or severe hidradenitis.

  In studies that led to its approval, the patients who received adalimumab had noticeably fewer abscesses (infected lumps with pus) and nodules (hard lumps beneath the skin) than the patients who did not receive this medication.

  Adalimumab is an injectable medication that comes in a prefilled pen or syringe. If your dermatologist prescribes adalimumab, you’ll learn how to give yourself injections so that you can treat yourself at home. Your first injection will be given (or supervised) by your dermatologist or nurse. Always follow your dermatologist’s instructions for taking this medication.

  The most common side effect is developing a reaction where you inject. The injected skin may become red/discolored, itchy, painful, or swollen. Other possible side effects include developing headaches or a serious infection, such as tuberculosis.

  • Brand names: Humira (biologic) Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Idacio, Simlandi, Yuflyma, Yusimry (biosimilars)

• Bimekizumab-bkzx: FDA approved to treat adults who have moderate-to-severe hidradenitis suppurativa, this biologic can:

  • Decrease the number of nodules (lumps beneath the skin) and abscesses (lumps that leaks pus or other fluid).
  • Prevent new nodules, abscesses, and other lesions from forming.
  • Reduce pain.

  Bimekizumab-bkzx works by targeting two proteins in the immune system that produce inflammation in people who have hidradenitis suppurativa.

  This biologic is available as an autoinjector pen or prefilled syringe, so you can give yourself the injections. You will be taught how to inject the medication, so you can do so safely. Always follow your dermatologist’s instructions for injecting.

  The most common side effects are infections, headaches, and a reaction where you injected the biologic.

• Brand name: Bimzelx

• Secukinumab: This biologic is FDA approved to treat patients 12 years of age and older who have moderate or severe hidradenitis suppurativa. This biologic can reduce:

  • Nodules (hard lumps beneath the skin)
  • Abscesses (pus-filled lumps)
  • Skin filled with pus

  In studies, after one year, more than 80% of patients had no increase in the number of draining tunnels. This is important because developing new tunnels is a sign that hidradenitis suppurativa is worsening.

  Secukinumab is an injectable medication. Before you use this medication for the first time, your dermatologist or nurse will show you how to inject it.

  The most common side effects are cold symptoms, diarrhea, and upper respiratory tract infections.

• Brand name: Cosentyx

• Infliximab: This medication may be prescribed to get moderate or severe hidradenitis suppurativa under control. It’s given as an infusion, so you may need to go to an infusion center, clinic, or hospital for treatment. Some patients are able to give themselves the infusions at home. 

  In studies, the most common side effects are flu-like symptoms and a reaction to the infusion. Symptoms of an infusion reaction include itching, flushing, headache, and shortness of breath. More serious side effects, including infections, can also occur.

  If a reaction occurs, it usually begins after you finish getting the infusion, usually within 30 minutes to 2 hours. Sometimes, it can take 24 hours or even a few weeks for a reaction to occur.

  • Brand names: Remicade (biologic)  Arsola, Infectra, Ixifi, Renflexis (biosimilars)

While you are receiving a biologic or biosimilar, your dermatologist will monitor you closely.

Upadactinib: This medication can reduce hidradenitis suppurativa on your skin and lessen the pain. If other treatments have not been effective, upadactinib may be an option.

This medication belongs to a class of medications called JAK inhibitors, which work by interfering with signals in the body that are thought to cause inflammation. By reducing inflammation, it’s possible to reduce symptoms like pain and lesions on your skin.

This is an oral (take by mouth) medication. Your dermatologist will tell you how often to take it.

In studies, some patients with hidradenitis suppurativa who took upadactinib developed side effects, including headache, dizziness, and urinary tract infection. More serious side effects are possible.

• Brand name: Rinvoq

Corticosteroid pills: This medication can work quickly to reduce hidradenitis suppurativa on your skin and lessen the pain. It may be prescribed to treat a flare-up or an increase in pain or drainage.

If this medication is an option, it’s prescribed short term. Taking it for a short amount of time helps to prevent the long-term side effects that can occur, such as your bones becoming more fragile and likely to fracture and your skin more likely to bruise or tear. Other possible effects of taking corticosteroids long term, include an increased risk of developing high blood pressure or diabetes.

To treat a flare-up, a corticosteroid may be prescribed along with an antibiotic, and sometimes, a medication that can make the antibiotic more effective.

Procedures

Some patients can benefit from a treatment plan that includes a procedure(s). A few of these in-office procedures are especially helpful if tunnels have formed in your skin.

Procedures that dermatologists use to treat hidradenitis suppurativa include:

• Corticosteroid injection: When injected, this medication can reduce inflammation. Dermatologists use this procedure to treat painful nodules, abscesses, and tunnels that are not infected.

• Laser hair removal: Reducing the amount of hair in skin with hidradenitis suppurativa can reduce the number of nodules and pus-filled bumps. Your dermatologist will tell you how many treatments you’ll likely need. Treatment is typically done once every 4 to 6 weeks. It may take months to see improvement.

• Botulinum toxin: While most people think of this medication as a treatment for wrinkles, the FDA has also approved botulinum toxin to treat excessive sweating. Your dermatologist may recommend this medication to reduce sweating, which can help reduce flares.

• In-office surgical procedure: Your dermatologist may recommend this type of procedure to drain a painful lump, treat a painful tunnel in your skin, or remove a lesion that keeps returning. 

  Before the procedure, your dermatologist will numb the area, so you don’t feel the surgery. You’ll remain awake during the procedure.

  To perform this type of surgery, your dermatologist will use a surgical blade, laser, or other surgical instrument(s) to treat you.

  To help prevent an infection and obtain the best results after surgery, you’ll need to care for the surgical wound at home.

  Possible side effects of an in-office surgical procedure include an infection and the possibility of the treated lesion returning. Your dermatologist knows how to minimize these risks by carefully selecting patients and following appropriate surgical methods.

About laser surgery: During an in-office procedure, your dermatologist may use a laser. Strong lasers can vaporize lesions. Before you have laser surgery, your dermatologist will prescribe medication to get hidradenitis suppurativa under control.

After laser surgery, it may take up to 6 months for your skin to heal.

Wound care

Wound care plays an important role in treating hidradenitis suppurativa, as some patients have slow-healing or non-healing wounds. If you need wound care, you will be taught how to do it at home. In the beginning, some patients need to cover their wounds with dressings and change these dressings several times a day.

What you use to care for your wounds can vary. Your dermatologist will consider where you have wounds, the amount of leakage coming from the wounds, and what the skin around each wound looks like. Cost and your preferences are also considered.

Pain relief 

Hidradenitis suppurativa can cause severe pain.

If you feel pain, tell your dermatologist.

While treatment for hidradenitis suppurativa can reduce pain, some patients continue to experience pain. The following describes possible treatments for each type of pain:

Sudden pain: As the names suggests, this type of pain occurs suddenly. When it does, you can feel burning, stinging, shooting, or stabbing. To relieve this type of pain, also called acute pain, your dermatologist may add one or more of the following to your treatment plan:

• Warm or cool compresses

• Lidocaine (you apply to areas with pain)

• Acetaminophen (a pain reliever)

• NSAID (includes aspirin, ibuprofen, or naproxen sodium, which can reduce pain and other types of inflammation)

• Injection of corticosteroids

• A procedure performed in the office, such as draining a lesion

• Corticosteroid pill (taken for a short time)

Occasionally, a patient needs to take an opioid. When an opioid is a possible treatment for pain, your dermatologist will talk with you about the realistic benefits and known risks of opioids. If you decide that an opioid is an option for you, you may see a doctor who specializes in pain management, a psychologist, or both. You will take an opioid for a limited time and be prescribed the lowest dose that will be effective for you.

Long-term pain: Also called chronic pain, this type of pain occurs when you’ve had hidradenitis suppurativa for some time and have deep lumps, widespread abscesses (pus-filled lumps), and tunnels under your skin. Long-term pain feels like gnawing, aching, tenderness, and throbbing. To treat chronic pain, your dermatologist may include one or more of the following in your treatment plan:

• Antidepressant

• Gabapentin or pregabalin

• Proper wound care

• Referral for psychotherapy

• Referral to a medical doctor who specializes in pain management

Supplements 

Zinc and vitamin D are two supplements that show promise in helping treat hidradenitis suppurativa.

While these can be helpful, it’s essential to take these and other supplements under a dermatologist’s guidance. Taking too much of a supplement, such as zinc or vitamin D, can cause health problems. Some supplements can interfere with medication in your treatment plan.

Your dermatologist can tell you:

• If a supplement could help improve the results you see from treatment

• How much to take

Here’s what the studies show about zinc and vitamin D:

Zinc: In a first study of its kind, dermatologists added a zinc supplement to the treatment plan of 22 patients who had mild-to-moderate hidradenitis suppurativa. All patients had improvement. After taking zinc, 8 patients had complete clearing of painful nodules and pus-filled bumps, along with no draining tunnels. Fourteen patients had some clearing. This result has been seen in other studies.

Nausea is a possible side effect of taking zinc. If you experience nausea or side effects like diarrhea or vomiting, tell your dermatologist.

To provide safe and effective treatment, your dermatologist will tell you how much zinc to take and watch you.

Vitamin D: If your vitamin D is low, your dermatologist may add this supplement to your treatment plan. In studies, when dermatologists added a vitamin D supplement to patients with low levels, patients had fewer nodules (hard lumps) and other lesions.

For your safety, your dermatologist will tell you if they recommend that you take vitamin D, and if so, how much to take. You may need a blood test to check your vitamin D levels.

Can a special diet help clear my skin of hidradenitis suppurativa? 

To date, we don’t have enough research to say whether diet can help reduce the amount of hidradenitis suppurativa on your skin or help your skin heal. Only small studies have been run. The findings from one study often do not agree with the findings from another study. For example, two studies that looked at the Mediterranean diet produced different findings.

If you have hidradenitis suppurativa and you’re interested in following a certain diet or discovering what happens when you stop eating certain foods, talk with your dermatologist. Your dermatologist can offer guidance.

Treatment for depression or anxiety 

Patients who have hidradenitis suppurativa can become anxious or depressed. If you have developed either, your dermatologist may recommend counseling or joining a hidradenitis suppurativa support group.

Self-care can help you get your best results from treatment 

To help patients get the best outcome from treatment, dermatologists recommend self-care. To see what dermatologists advise, go to Hidradenitis suppurativa: Self-care.

Images
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References
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U.S. Food and Drug Administration (FDA) package insert:

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• Secukinumab (last revised 4/2026). Last accessed 9/2026.

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Written by:
Paula Ludmann, MS

Reviewed by:
Jennifer Adams, MD, DTM&H, FAAD
Steven Daveluy, MD, FAAD
Kelley Redbord, MD, FAAD
Abigail Waldman, MD, FAAD

Last updated: 10/20/26