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.

Deciding Your Treatment

Your doctor will help you come up with a game plan based on several things, including:

  • How much your symptoms bother you
  • Where your bumps and lesions are
  • What other medical conditions you have

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:

  • How many abscesses, or pus-filled bumps you have
  • Whether or not you have scarring

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.

Medicines for Your HS

Antibiotics 

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:

  • Doxycycline (Doxy-100, Monodox, Targadox)
  • Erythromycin (E.E.S. 400)
  • Minocycline (Minocin)
  • Rifampin (Rifadin)
  • Tetracycline (Sumycin)
  • Trimethoprim/sulfamethoxazole (Bactrim)
Steroids

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.

Biologics

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:

  • Anakinra (Kineret)
  • Canakinumab (Ilaris)
  • Etanercept (Enbrel)
  • Secukinumab (Cosentyx)
  • Ustekinumab (Stelara)
Hormone Medications

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:

  • Finasteride (Propecia, Proscar)
  • Spironolactone (Aldactone, Carospir)

But you can’t take these if you’re pregnant or want to become pregnant.

Metformin (Glucophage, Glumetza).

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.

Medicines for Your HS Symptoms

Antiseptic Washes

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:

  • Benzoyl peroxide 5% (antimicrobial wash)
  • Chlorhexidine 4% (antimicrobial wash)

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.

Pain Medicines

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.

Anticonvulsants

These drugs can help ease some of your nerve pain. Examples include:

  • Gabapentin (Gralise, Neurontin)
  • Pregabalin (Lyrica)
Antidepressants

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.

Oral Retinoids

These usually treat acne. They may ease inflammation. You’ll take them by mouth for several months. Common options used for HS include:

  • Acitretin (Soriatane)
  • Isotretinoin (Accutane, Sotret)

Tell your doctor if you’re pregnant or want to be. These drugs can hurt your baby.

Resorcinol

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.

Radiation

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:

  • Skin itchiness
  • Redness
  • Peeling
  • Sores

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.

Surgery

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:

  • Take away some bacteria and inflammation
  • Destroy hair follicles
  • Burn off scar tissue

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.

Reviewed By Brunilda Nazario, MD on October 20 2021

William Damsky, MD, dermatologist, Yale Medicine. 
American Academy of Dermatology: “Hidradenitis Suppurativa: Diagnosis and Treatment,” “How to Care for Your Skin During and After Radiation Therapy.”  
Anais Brasileiros de Dermatologia: “Consensus on the treatment of hidradenitis suppurativa – Brazilian Society of Dermatology.” 
Therapeutic Advances in Chronic Disease: “Topical, systemic and biologic therapies in hidradenitis suppurativa: pathogenic insights by examining therapeutic mechanisms.” 
Merck Manuals: “Hidradenitis Suppurativa.” 
UpToDate: “Hidradenitis suppurativa: Management.”
Skin Appendage Disorder: “Medical and Surgical Treatment of Hidradenitis Suppurativa: A Review.” 
NHS (UK): “Hidradenitis suppurativa (HS).” 
Indian Journal of Dermatology: “Hidradenitis Suppurativa: Inside and Out.” 
Scientific Reports: “Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa.” 
Genetic and Rare Diseases Information Center (NIH): “Hidradenitis suppurativa.” 
International Journal of Women’s Dermatology: “A concise clinician’s guide to therapy for hidradenitis suppurativa.” 
Immunotherapy: “Biologics for hidradenitis suppurativa: and update.” 
Journal of the American Academy of Dermatology: “North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations. 
Mayo Clinic: “Resorcinol (Topical Route).”
Clinical and Experimental Dermatology: “Resorcinol peels as a possible self-treatment of painful nodules in hidradenitis suppurativa.” 
Skin Appendage Disorders: “Botulinum Toxin Off-Label use in Dermatology: A Review.” 
Dermatology Online Journal: “The role of radiotherapy in the treatment of hidradenitis suppurativa: Case report and review of the literature.” 
American Cancer Society: “Second Cancers Related to Treatment.” 
ClinicalTrials.gov: “Low Dose Radiotherapy for Advanced Hidradenitis Suppurativa (RTHS).” 
Expert Review of Dermatology: “Laser and light-based treatments of hidradenitis suppurativa.” 
Plastic and Reconstructive Surgery: “Treatment of hidradenitis suppurativa with intense pulsed light: a prospective study.” 
Dermatologic Clinics: “Lasers and Intense Pulsed Light Hidradenitis Suppurativa.” 
National Organization for Rare Disorders: “Hidradenitis Suppurativa.” 
American College of Rheumatology: "TNF Inhibitors."