How to Treat Blocked Hair Follicles
There isn’t a cure for hidradenitis suppurativa (HS), the inflammatory skin condition that causes blocked hair follicles. But there are many different treatments that your doctor can give you that can ease your symptoms and make flare-ups less likely.
Your doctor will help you come up with a game plan based on several things, including:
Something called your Hurley stage also plays a big role. That tells you and your doctor how serious your condition is. Your Hurley stage is based on:
They’ll also check for tunnels, or sinus tracts. These form when your blocked hair follicles blow up like a balloon and burst under your skin. You can get a kind of drainage river of foul-smelling pus that connects the bumps.
Once your doctor figures out your Hurley stage and which treatment options are best, they'll go over the pros and cons of each. Don’t give up if the first treatment they give you doesn’t work. You may need to try more than one before you find the right option for you.
Your doctor might want you to take antibiotics by mouth. It's not because you have an infection, though HS can sometimes cause a secondary infection.
It’s unclear exactly how antibiotics work on HS. Experts think it could be because of the way antibiotics affect bacteria. They might also change the way your body reacts to what’s on or under your skin. That change seems to calm inflammation, which eases symptoms.
You may only need to take antibiotics for a week or 10 days. But if your condition is serious, you may have to use them for a few months or up to a year. Your doctor will decide.
Some common antibiotics used for HS include:
As long as you don’t have an infection, your doctor might give you a shot of a corticosteroid called triamcinolone. They’ll put it inside your HS lesion. It can ease inflammation, help your lesions heal, and help keep new ones from popping up.
It can be a good option if you only have one or two affected areas that don’t come back very often.
If you have a serious flare and need to get it under control, your doctor might suggest that you take oral steroids for 10-14 days. But steroids can cause unwanted side effects, so doctors won't suggest them as a long-term treatment for HS.
These are drugs that change how your immune system works.
You get them through a shot in order to ease inflammation or calm lesions. They treat other inflammatory conditions such as rheumatoid arthritis or psoriasis. They can also help with inflammatory bowel diseases like Crohn’s disease or ulcerative colitis.
Your doctor will likely start you on a biologic if your HS is moderate or serious, or if other treatments haven’t helped. They’re a long-term treatment that you can take for many years.
They can cause some unwanted side effects. The most common is a higher chance of infections.
Your doctor may give you:
Adalimumab (Humira). This is the only biologic approved by the FDA to treat moderate to severe HS. If your doctor puts you on a biologic, they’ll likely start with this one.
Infliximab (Remicade). This isn’t FDA-approved to treat HS, but doctors have used it to do so for a while.
There’s some evidence that other biologics can help HS, too. These include:
If your body makes too much of a type of hormone called androgen, it could lead to HS. Your doctor can check to see if you make too much of it. If you’re female, they might test you for a condition called polycystic ovarian syndrome (PCOS).
If need be, your doctor can prescribe drugs to block the effects of androgen, including:
But you can’t take these if you’re pregnant or want to become pregnant.
Experts aren’t sure how this drug helps with HS. It might help control androgen levels. It’s also a way to manage type 2 diabetes and metabolic syndrome. Diarrhea and nausea are metformin's most common side effects.
You don’t get HS because you’re dirty or because you have an infection. But your doctor might suggest an antiseptic or antibacterial wash to ease your symptoms.
Some common antiseptic washes used for HS include:
An antibiotic gel may work better than a wash if your HS is mild. Clindamycin is an antibiotic gel that's often used for HS. Ask your doctor about it.
Blocked hair follicles can really hurt. This can make it hard to do daily activities. The best way to treat your pain is to get your HS under control. But in the meantime, your doctor may refer you a pain specialist to come up with a plan. They might want you to try:
NSAIDs (non-steroidal anti-inflammatory drugs). These can ease mild pain and lessen swelling. You’ll take them by mouth. Some over-the-counter (OTC) options include ibuprofen and naproxen.
Acetaminophen. This oral drug can ease mild pain. Use it exactly as directed. Too much of this can cause serious liver damage.
Skin-numbing treatment. This includes gels like lidocaine.
Opioids. These are stronger drugs that can help with short-term pain. You can only get them with a prescription. Take them exactly as prescribed, as they carry dangerous risks.
These drugs can help ease some of your nerve pain. Examples include:
These can dampen pain signals from your nerves. They can also help treat anxiety or depression, which are really common if you have HS. There are many different types. If you feel pain, or if you're starting to feel depressed, talk with your doctor to see if they should be part of your treatment plan.
These usually treat acne. They may ease inflammation. You’ll take them by mouth for several months. Common options used for HS include:
Tell your doctor if you’re pregnant or want to be. These drugs can hurt your baby.
This is a cream that can remove hard skin. We need more research, but there’s some evidence that putting this on your skin twice a day can ease painful HS symptoms. It’s used to treat other skin conditions, like eczema and psoriasis.
A few reports show that radiation might help some people with HS. But it’s not used often to treat blocked hair follicles. It can cause unwanted side effects that can include:
Radiation therapy may also raise your chances of some kinds of cancer. With that said, there’s ongoing research to see if low-dose radiotherapy might be a future treatment for HS.
There isn’t an exact time that you'll need surgery for HS. But your doctor might steer you toward certain procedures sooner if your HS is very serious or if medicine doesn’t help very much.
Options include:
Open and drain bumps. This is a quick way to ease really bad pain from an abscess. But it’s not a good way to manage your condition in the long run. Your bumps will come back eventually.
Deroofing. Your doctor can take off the layer of skin over a sinus tract or abscess. They might use scissors, a blade, or a laser. They’ll clean the area and leave it open to heal on its own. You can leave the hospital the same day. One small study found that more than 80% of people with Hurley stages I and II had no new lesions nearly 3 years after this kind of procedure.
Laser and light therapies. These can:
Your skin might hurt or get irritated. And it can take up to 6 months for your skin to heal afterward.
Wide excision. This is when you have the tissue and glands around your HS lesions removed. It’s easiest to do this in your armpits. But it’s possible to take out some tissue around your buttocks, genitals, and breasts, too.
Your dermatologist will likely refer you to a plastic surgeon for it. You’ll need someone who can repair your skin after they take your affected tissue out. Your doctor will call it reconstruction surgery.
Excision can essentially “cure” the disease in some people. But there’s a chance your bumps will come back later.
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