Hidradenitis suppurativa management (Treatment and management of hidradenitis suppurativa)

What does hidradenitis suppurativa management involve?

Hidradenitis suppurativa (HS) is a long-term skin condition in which painful, boil-like lumps, abscesses, and sometimes tunnels under the skin develop in areas that rub together, such as the armpits, groin, buttocks, and under the breasts. Over time it can cause scarring. It happens when hair follicles become blocked and inflamed, and it is not caused by poor hygiene or by being infectious.

Managing HS is about controlling the condition rather than curing it. The aim is to reduce how often flares happen, ease pain, treat infections, limit scarring, and support quality of life. Treatment is usually long-term and often combines several approaches.

Options include lifestyle measures (such as stopping smoking and weight management, which can genuinely help), antiseptic skin care, antibiotics (short courses for flares or longer courses to calm inflammation), hormonal treatments in some people, biologic injections that target the immune process for moderate to severe disease, and surgery to remove or open up persistent areas. Pain relief and emotional support are important parts of care.

It is important to be honest about expectations. HS is chronic and tends to come and go for years, treatments help to differing degrees, and some people need to try several before finding what works. Early diagnosis and treatment can reduce long-term damage.

Types, options & approaches

There may be different ways to do this. The right approach depends on the clinical question and your circumstances.

Treatment by severity (general guide)

Severity is judged by a dermatologist, not by these rows alone, and treatments are often combined. The right plan depends on how active and widespread the disease is and how it affects you.

Preparing for your treatment

• Note where your lumps occur, how often you flare, and how much pain and disruption they cause.
• Be ready to discuss smoking and weight honestly, as both can affect HS and its treatment.
• List all your medicines, allergies, and anything that has helped or not helped before.
• Mention any joint pains, bowel symptoms or other health problems, as HS can be linked to other conditions.
• Tell the team if you are pregnant, breastfeeding or planning a pregnancy, as this affects treatment choices.
• If biologics may be considered, expect screening tests (such as for infections) beforehand.
• Bring questions about realistic results, how long treatments take to work, and pain control.

What happens

A dermatologist confirms the diagnosis, usually from the pattern and sites of the lumps and your history, and assesses how severe and active the condition is. Together you discuss the impact on your life, including pain and mood, and agree a plan.

Depending on severity, this may start with self-care, antiseptics and antibiotics, and move on to longer courses, hormonal treatment, or biologic injections for more severe disease. Before biologics, you usually have screening tests, and you are then monitored during treatment. Surgery is arranged when areas remain persistently troublesome despite medicines.

Throughout, good pain management, advice on flares and wound care, and support for the emotional impact are part of treatment. Because HS fluctuates, the plan is reviewed and adjusted over time rather than fixed at one visit.

Is this treatment right for me?

A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.

Before you decide

Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.

Comfort, sedation or contrast choices

If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.

The main reality is that HS is controlled rather than cured, and finding the right combination can take time. Biologics are effective for many but suppress part of the immune system, so screening and monitoring matter. If surgery is considered, ask about healing, scarring and the chance the condition returns nearby. Pain and mood should be addressed, not overlooked.

Published figures to discuss

How well HS responds depends on its severity, how active it is, which treatment is used, and individual factors, so outcomes vary widely. Biologics help many with moderate to severe disease but not everyone, and they carry a recognised but individually variable risk of infection, which is why screening and monitoring are standard. Surgical recurrence near treated sites is well described but hard to put a single figure on. Because of this variability, we describe outcomes and risks in words rather than quoting precise percentages, which could mislead.

These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.

What happens afterwards

HS management is ongoing rather than a single treatment with a fixed recovery. "Afterwards" means watching for fewer or milder flares over weeks to months, managing any side effects, and reviewing whether a treatment is worth continuing. Surgery has its own recovery.

• Flares that still come and go while treatment takes effect
• Some side effects when starting a new medicine that often settle
• Slow wound healing after surgery, sometimes over several weeks
• A period of trial and adjustment to find the right combination

Aftercare

• Take medicines exactly as prescribed, including completing or continuing courses as advised.
• Attend monitoring tests if you are on a biologic or other medicine that needs them.
• Look after flares and any wounds with the dressings and washes recommended.
• Use the pain relief plan agreed with your team, and ask for review if pain is not controlled.
• Continue lifestyle measures, such as not smoking, that can reduce flares.
• Know the warning signs of serious infection, especially while on a biologic, and who to contact.
• Seek support for your mood and wellbeing if HS is getting you down.

• A record of where and how often you flare, and what helps
• An honest note on smoking and any weight goals
• A full list of medicines and allergies
• Awareness of screening tests needed before biologics
• A pain management plan you understand
• Knowledge of warning signs and who to contact
• A source of emotional or peer support

Scars and how they heal

HS itself can cause scarring and skin tunnels over time, which is one reason to treat it early. Surgery deliberately creates wounds: some are left open to heal slowly from the bottom up, and all can leave scars, which may occasionally limit movement in areas such as the armpit. Your surgeon will explain the likely scar and healing for the specific operation.

⚠ Get urgent help if…

• Spreading redness, severe pain, swelling or fever suggesting a serious infection
• Feeling generally unwell, shivery or feverish while taking a biologic (possible serious infection)
• A new cough, night sweats or weight loss while on a biologic (possible reactivated infection)
• A wound that is increasingly painful, breaking down, or heavily bleeding after surgery
• Signs of a severe allergic reaction to a medicine, such as widespread rash, swelling or breathlessness
• Thoughts of self-harm or being unable to cope, which need urgent support

Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.

General guidance — it doesn't replace the specific advice your specialist gives you.

Results & realistic expectations

A good result is fewer and milder flares, better pain control, and less new scarring, allowing a more comfortable daily life. For moderate to severe disease, biologics can produce a meaningful improvement in those who respond, and surgery can clear areas that never settle.

Results are not a cure. HS tends to persist and fluctuate for years, treatments help to differing degrees, and the condition can flare again or appear in new areas. Finding the most effective combination can take time, and ongoing treatment is often needed to stay in control.

HS is a chronic condition that often continues for many years, though it can eventually become less active. Treatments generally work while they are continued; flares may return if they are stopped, and disease can recur near surgical sites. Because activity changes over time, management is reviewed and adjusted rather than completed once.

Related tests, treatments or support

Treatments are frequently combined, for example self-care and antibiotics together, or medical treatment alongside surgery for stubborn areas. Pain management and emotional support run throughout. Because HS is linked with conditions such as inflammatory bowel disease and joint problems, care may also involve other specialists, and general health measures like stopping smoking benefit overall wellbeing.

Follow-up & long-term care

You are reviewed regularly to judge whether treatment is reducing flares, to monitor for side effects, and to adjust the plan. Biologics in particular involve ongoing monitoring. Surgical wounds are followed up until healed. Pain and mental wellbeing should be checked at reviews, with onward referral where needed.

• Continue effective treatments for as long as advised, as benefit may fade if stopped.
• Attend monitoring blood tests and reviews, especially on biologics.
• Keep up lifestyle measures, particularly not smoking, that reduce flares.
• Maintain a flare and wound care routine that works for you.
• Stay engaged with pain management and emotional support over the long term.

Repeat, follow-on and what comes next

• Treatments are commonly changed, combined or escalated as response is reviewed.
• HS can recur near surgical sites, and further procedures are sometimes needed.
• Biologics may lose effect over time, prompting a switch.
• Finding an effective long-term combination often takes more than one attempt.

Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.

What good aftercare looks like

• A named contact and clear plan for managing flares and wounds.
• Appropriate monitoring for biologics and other medicines.
• A genuine pain management plan, reviewed if pain is not controlled.
• Regular review to adjust treatment as the condition fluctuates.
• Access to psychological or peer support for the impact of HS.

What affects the cost

Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:

• How severe and widespread the disease is
• Which treatments are used (antibiotics, hormonal treatment, biologics or surgery)
• The cost and monitoring of biologic medicines
• Whether surgery is needed and how extensive it is
• The seniority and experience of the dermatologist or surgeon
• Whether pain management and dressings are included
• Whether follow-up and emotional support are included

• The dermatologist's consultation and review fees
• The cost of biologics and the monitoring they require
• The cost of any surgery, anaesthetic and aftercare
• Whether dressings, wound care and pain management are included
• Whether follow-up appointments are included
• What happens if a treatment does not work and is changed
• The cancellation policy and who to contact with concerns

On the NHS? Hidradenitis suppurativa is managed on the NHS, including specialist care, biologics for those who meet the criteria, and surgery; private care is mainly used for speed or choice of specialist.

You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.

Consent traps and marketing red flags

These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.

Choosing a specialist safely

• Check the specialist is on the GMC Specialist Register for this area.
• Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
• You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
• Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
• You're entitled to your total cost in writing — including any follow-up — before you decide.

How Vuemedics verifies every consultant →

Take this to your consultation. A good specialist will welcome every one of these.

• How severe is my HS, and which treatments make sense at this stage?
• How long should each treatment have before we judge whether it is working?
• If a biologic is suggested, what screening and monitoring will I need, and what are the risks?
• What is the plan for controlling my pain during flares?
• If surgery is needed, what does healing involve, and could the disease come back nearby?
• What support is available for the emotional impact of HS?
• Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
• Will you be the specialist who carries out my treatment, and who looks after me afterwards?
• What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
• What does a realistic result look like — and what can this treatment not achieve?
• What are my options, including waiting, doing nothing for now, or choosing a different approach?
• Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
• What is the total cost in writing, including any follow-ups, and how much time do I have to decide?

Find a verified specialist for hidradenitis suppurativa management

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How we made this page

Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →

Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.

Sources & standards: NHS — Hidradenitis suppurativa (HS) British Association of Dermatologists — Hidradenitis suppurativa British Skin Foundation — Hidradenitis suppurativa NICE — Adalimumab for treating moderate to severe hidradenitis suppurativa (TA392) Hidradenitis suppurativa: clinical review — PMC Two phase 3 trials of adalimumab for hidradenitis suppurativa — PubMed

Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.

Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.