Hidradenitis Suppurativa Treatment in Houston

Living with hidradenitis suppurativa (HS) can be very painful, isolating, and incredibly frustrating. At Texas Hidradenitis Center, we provide personalized treatment remedies to reduce painful flare-ups, minimize inflammation, and guide patients through long-term HS treatment plans. Whether you have been recently diagnosed, undiagnosed, or have been struggling with HS for many years, at Texas Hidradenitis, we’re determined to provide solutions for you.

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What Is Hidradenitis Suppurativa?

Hidradenitis Suppurativa (HS) is a chronic auto-inflammatory skin condition. Because the nature of HS is a chronic condition, there are no permanent cures. However, with the proper treatment plan, patients can manage their symptoms, minimize the frequency of flare-ups, reduce complications of HS, and preserve the quality of life that they deserve. HS can be consuming; however, it is not contagious, sexually transmitted, infection, nor due to improper hygiene. HS may be a lot of things, but what it is not is that it’s not your fault.

Common Symptoms

HS symptoms consist of small, raised areas of the skin, often with blackheads. These areas often turn into inflamed bumps or nodules that may get larger and burst. These painful lesions will typically drain pus and fluid, which may result in further itching, irritation, and unpleasant odors. These abscesses heal very slowly, often recurring with oozing and drainage, thus resulting in scarring on the surface of the skin and tunneling beneath the skin.

What Causes HS?

The exact cause of HS may vary between patients; however, the nodules generally form from inclusion of the hair follicles, most observed in the groins or folds in the body. HS is seen most often manifesting in the armpit/axillary, groin, and inner thigh areas. While the exact causes of these blockages are unknown, research shows that they may be due to genetic predisposition, environmental factors, hormonal composition, or some variation of all three.

Who is at Risk?

Anyone can develop HS, though it has been observed to be more predominant in women, with women being three times more likely than men, and for black women, even more prevalent than other racial groups.

How is HS Diagnosed and Staged?

Hidradenitis Suppurativa (HS) is diagnosed by a combination of clinical examination and symptom manifestation. Since HS is the result of inflammation rather than an infection, it cannot be diagnosed via a swab test. Our providers may look at the sites of recurring lesions, determine if they are connected, and if they are, then how they are connected. This may include examination of tunneling beneath the skin and peak of the nodules.

Hidradenitis Suppurativa (HS) is separated into three stages called Hurley stages. These stages increase from mild to moderate to severe. Though there are three distinct stages, they do not represent the story of each patient. These stages serve as a guideline for different treatment options and plans that patients may consider.

Early diagnosis and treatment can prevent progression and scarring.

Hurley Stage I

Hurley stage I (mild) is classified as one or several nodules or abscesses. Stage I is when patients do not experience tunneling and tracts beneath the skin. Patients also have limited or very little scarring on the surface of the skin.

Hurley Stage II

Hurley stage II (moderate) is defined by recurrent nodule formation, rather than those that diminish with treatment. The abscesses often occur in various locations and appear more generalized than in Hurley stage I. Hurley stage II patients usually experience tunneling beneath the surface of the skin, and lesions may drain pus or ooze, periodically. Patients also experience more scarring of skin tissue than patients under Hurley stage I.

Hurley Stage III

Hurley stage III (severe) is seen when patients experience a wide area of inflammatory tissue. The abscesses in Hurley stage III patients are typically longer-term, meaning the nodules remain active even with treatment. Along with the constantly active nodules, patients often experience much more drainage from the abscesses, many interconnected tunnels, and significant scarring of the affected areas of the skin.

Stage	Symptoms	Treatment
Hurley stage I	Few small nodules	Topical and oral medications
Hurley stage II	Recurrent abscesses	Oral medications and biologics
Hurley stage III	Tunnels and major scars	Biologics and surgical excision

Treatment Approach

Treatment Options by Hurley Stage

For many patients with Hidradenitis Suppurativa (HS), treatment is more than a one-and-done solution. Many patients will need care packages involving tailored medicinal approaches alongside modifications to lifestyle habits to achieve an effective remedy. For most HS patients, treatments may start with a trial of aggressive prescription topicals and oral medications, then progress to biologic injections and surgery. Working alongside our providers at Texas Hidradenitis, patients are able to find relief and get back to doing what they love.

Treatments for Mild HS

For many patients with mild HS symptoms, the first line of medication for simple HS onset involves the use of prescription topical medications. Combined with oral medications like antibiotics or antiandrogens, many patients with mild HS symptoms can find relief in topical and oral medication remedies. Other treatments for mild symptoms of HS include punch debridement. This is a procedure that can be done on very small abscesses to prevent the enlarging of nodules and the formation of tunnels. Intralesional corticosteroid injections have also proven effective at reducing the inflammation and pain associated with inflammation in small nodules of early HS.

Treatments for Moderate HS

For patients with moderate HS symptoms who have failed the first line of treatment, systemic antibiotics and biologic injections should be considered. The use of biologics, potentially with oral medication, for patients who have been unresponsive to aggressive topical prescriptions, often alleviates many of the irritations and symptoms caused by HS. Patients may also benefit from wide deroofing and debridement of individual tunnels; however, these approaches may not be the most efficient at treating HS for patients who have very wide involvement in skin tissue.

Treatments for Severe HS

For patients with severe symptoms of HS, surgical procedures may be beneficial for accomplishing remission from HS sites with widespread involvement in skin inflammation, tunneling, and scarring. Patients with severe HS symptoms over a wide area with widespread involvement may be considered for surgical excision with the complete removal of all margins where tunneling and abscesses occur. For patients with gluteal, perineal/perianal, and axillary HS, wide excision is the most effective treatment option relative to conservative approaches like debridement and deroofing. Wide surgical excision and biologic injections have proven to relieve and maintain the symptoms of severe HS.

Medical Treatments

Topical and Oral Medications

As the first line of therapy for Hidradenitis Suppurativa (HS) patients, most patients diagnosed with HS will have or have had exposure to one, if not more, of some of the following medications. If HS is diagnosed early in onset, treatment with topical antibiotics combined with systemic antibiotics or hormonal therapies have very high efficacy at managing the symptoms of HS.

Topical Antibiotics

Although HS is not an infection, treatment with topical clindamycin, a topical antibiotic, combined with oral antibiotics or hormonal therapies have proven to be the most effective at targeting early symptoms caused by HS. This is attributed to the anti-inflammatory properties of topical clindamycin. Many patients observe reduction in the number of abscesses, inflamed nodules, and pustules when prescribed topical clindamycin 1%.

Oral Antibiotics

Systemic antibiotic medications have shown to reduce inflammation and flare-ups for patients with mild to moderate HS symptoms. Oral tetracyclines such as doxycycline or minocycline are the most prescribed traditional medications for treating HS and have proven to be very effective. Tetracyclines work by a mechanism of targeting and suppressing lymphocytes, neutrophils, and histiocytes, thus prescribed for their anti-inflammatory properties. These oral antibiotics are often prescribed in combination with topical therapy, such as clindamycin.

Hormonal Therapies

For patients with mild to moderate HS symptoms, hormonal therapies may be beneficial. Increased androgen levels are thought to play a role in the development of new lesions in HS patients. Spironolactone is often prescribed for patients when HS is suspected to be rooted in upregulated hormonal levels. Spironolactone is contraindicated for women who are pregnant or planning to be, due to potential birth defects, and may cause gynecomastia in men.

Pain Management

Pain from the nodules and tract formation associated with HS can be temporarily relieved by intralesional corticosteroid injections. These injections have shown in studies to reduce the inflammatory and painful properties of nodules and prevent fluid formation and build-up. Punch debridement can also be considered for small nodules to prevent the development into abscesses and tunneling beneath the skin. Punch debridement is the process of using a punch biopsy blade to remove the main part of the nodule and allow the wound to heal itself from the bottom up.

Advanced Treatments

Biologic Therapy

The next level of treatment therapies for Hidradenitis Suppurativa (HS) patients are biologic subcutaneous injections. These therapies are more targeted and enter the bloodstream to treat HS symptoms from the inside out. Many patients who have contraindications to or are unresponsive to aggressive topical and oral therapies generally respond well to biologic injections. Humira (adalimumab), Cosentyx (secukinumab), and Bimzelx (bimekizumab) are all FDA-approved biologics for the treatment of moderate to severe chronic HS.

Who Is a Candidate?

The Food and Drug Administration (FDA) approves the use of biologic therapies for patients diagnosed with moderate to severe HS. These patients are those indicated by Hurley stages II and III. Patients are eligible for biologic therapies upon meeting the threshold of nodule and abscess count, along with symptoms of extensive or progressive scarring and tunneling and frequent flare-ups.

How Long Until Results?

Duration and cosmesis of results vary between patients, with most studies lasting about 12-16 weeks. Some patients report relief of symptoms as early as one month of treatment. Adalimumab studies generally lasted for a duration of 12 weeks, while secukinumab and bimekizumab studies typically lasted over a period of 16 weeks.

Risks and Benefits

HS patients who are on biologic therapies have seen a reduction in the development of sinus tracts and scar development. Studies have shown ≥50% reduction in total nodule and abscess count with no increases in drainage and tunneling over the period of the study. Adalimumab contraindications include congestive heart failure and demyelinating disorder, with side effects of immunosuppression, infection, and paradoxical rashes, while secukinumab and bimekizumab side effects include mucocutaneous candidiasis and paradoxical rashes.

Procedural Treatments

Laser and Surgical Options

Aside from being a medical condition, hidradenitis suppurativa (HS) is also a surgical condition. Patients with moderate to severe HS symptoms benefit from surgical procedures to restore the skin. Laser hair removal may also be discussed with providers to reduce potential development of new HS lesions and nodules.

Laser Hair Removal

Laser hair removal (LHR) is a cosmetic procedure that may benefit many patients with HS. LHR uses focused light beams to heat and damage hair follicles. This procedure can be especially beneficial in the gluteal, perineal/perianal, and axillary areas where patients may manifest symptoms of HS. HS nodules develop from blockages of the hair follicles, thus LHR eliminates the hair follicle and minimizes the risk of development of new HS lesions. This is especially beneficial for patients with early diagnoses and onset of HS and patients who have had surgical excision to remove the areas of skin involvement.

Deroofing

Patients with moderate to severe tunneling aiming for a more conservative surgical approach may be offered a deroofing procedure. This procedure aims to clear the drainage of the sinus tracts to help reduce the inflammation in the surrounding areas. Deroofing involves entering the tunnels and removing the roofs of the tunnels with surgical scissors allowing the tunnels to drain the pus and build-up that may relieve the additional pain caused by this build-up.

Wide Excision

Patients struggling with moderate to severe HS with widespread involvement of skin may be consulted for a wide excision. The procedure consists of surgically removing all the involved tissue, including nodules, abscesses, tunnels, and removing all clinically apparent margins of HS manifestation in the area. After surgery, the skin is left to heal by secondary intention, healing from the bottom up. At Texas Hidradenitis, we specialize in HS excisions and helping patients heal and get back to everyday life.

When Surgery is Recommended

Wide surgical excision is the most effective, definitive treatment for patients with moderate to severe manifestations of HS abscesses. Studies have shown that conservative approaches such as debridement and deroofing have little benefit for patients with HS developments in gluteal, perineal/perianal, and axillary areas of the body. If patients are not responsive to oral and biologic therapies, surgical excision may be the solution.

Our Difference

Why Patients Choose Texas Hidradenitis

At Texas Hidradenitis, we offer patient-centered care with one thing in mind, you. From the extensive research poured into our program, to the friendly healthcare team greeting you every visit, we’re here to help. We offer HS-expertise backed by evidence-based patient care, personalized treatment plans tailored to each patient, and long-term hidradenitis suppurativa management.

Dr Harrison Nguyen hidradenitis suppurativa specialist at Texas Hidradenitis Center

Dr. Harrison P. Nguyen, MD, MBA, MPH

Trishann T. Nguyen, PA-C

FAQs

Frequently Asked Questions

Find answers to common questions about hidradenitis suppurativa treatment, medications, surgery, and long-term management.

Is hidradenitis suppurativa curable?

Hidradenitis suppurativa (HS) is a chronic disease with no known cure, but there are many therapies approved to help manage the symptoms of HS.

What is the best treatment for HS?

Treatment plans vary from patient to patient. We offer patient-focused care and long-term management of HS symptoms.

Are biologics safe?

Biologics are generally considered safe and approved methods of treating auto-inflammatory diseases such as HS.

Can HS come back after surgery?

HS can come back after surgery; however, with long-term management, we can closely monitor the signs and symptoms after surgical procedure.

Is HS contagious?

HS is not a contagious disease, rather an auto-inflammatory disease.

Does weight loss help HS?

Speak with a provider today about how weight loss can help your symptoms of HS.

What foods trigger HS?

Obesity, smoking, and environmental factors can be triggers for HS, as well as patients being genetically predisposed.

How long does treatment take?

Treatment duration varies from patient to patient. HS is a chronic condition, meaning we will work with you to manage your HS long-term.

When should I see a dermatologist?

See a dermatologist as soon as signs and symptoms start appearing.

Can smoking affect HS?

Yes, studies have shown that smoking is a potential trigger for HS.

Ready to Find Relief from Hidradenitis Suppurativa?

Dealing with Hidradenitis Suppurativa (HS) may feel debilitating, but don’t let it stay that way. At Texas Hidradenitis Center, we’re here to help you and work alongside you to restore your quality of life. Let us help you manage your HS symptoms and provide the medical, research, and surgical care that you need.