Hidradenitis starts because the hair follicles and apocrine glands (sweat glands in the groin, underarms, buttocks and underneath the breasts) become clogged, and infected, leading to painful cysts. When the cysts burst, they spread the infection to nearby glands, starting the process again. Over time, the cysts develop connections between them, known as sinus tracts, making it even easier for the infections and inflammation to spread. When your doctors treat hidradenitis, they want to stop two major processes: the infection and the inflammation. The therapies they will recommend are designed to stop both.
There are five different approaches to treating hidradenitis. Your doctor will discuss the right one for you, depending on the severity of your condition.
Treatments for Hidradenitis
Our doctors understand how much inflamed hair follicles and sweat glands can affect your quality of life. We have committed to understanding and treating this condition from a medical perspective. Our approach to treating hidradenitis involves evaluating patients from both the physical and behavioral medicine perspectives and trying conservative treatments before considering surgery.
Our doctors have found through research and experience that applying several different treatments and therapies at the same time result in the best overall outcome. This is why they will ask you to try a few different therapies at the same time to determine what the right treatment protocol is for you.
After talking to you and discussing your history managing hidradenitis, your doctor will probably recommend two or more of the following therapies:
Taking antibiotics by mouth means your entire body absorbs the infection fighting medication. This is known as systemic therapy (for your whole system), and can help stop the infection that begins in the hair follicles and nearby apocrine (sweat glands), usually located in the underarms, buttocks, groin, and for some women, under their breasts.
Medications to Reduce Inflammation
There is a class of medications you take by mouth, called systemic immunomodulators, that can help stop the inflammation. These medications stop the inflammatory cascade, which is the spread of the infection from one gland to the next.
Topical Antibacterial Washes
Using prescription strength antibacterial body washes can be helpful for fighting the infections that may develop inside the glands that lead to the painful cysts.
Surgical Opening of the Cysts
Depending on where your cysts are, and how many you have, your dermatologist may recommend consulting with a plastic surgeon, to open and drain the cysts in a controlled fashion.
By opening and draining the cysts, the hope is that the cysts won’t rupture and spread their contents on their own. In this way, the spread of further cysts is stopped.
Your doctor will discuss if this approach is right for you.
Laser Hair Removal
Laser hair removal shrinks or destroys the hair follicles. If the hair follicles aren’t there, the process by which they become infected can’t start. Our dermatologists have found that laser hair removal is often most effective for patients with mild to moderate hidradenitis.
Behavioral Pain Management
Nonpharmacological or behavioral medicine approaches may be recommended to help reduce pain or stress that often accompany hidradenitis. Best practices for optimal management indicate the need for behavior medicine specialists who understand the medical and physical aspects of hidradenitis and can provide individualized approaches for reducing pain and stress. Our specialists in behavior medicine work as part of a multidisciplinary team with dermatologists and surgeons and understand the range of physical and behavioral effects of hidradenitis; they will collaborate with you to create an individually tailored plan to improve your quality of life, in conjunction with traditional medicine approaches. Our behavior medicine doctors rely on empirically-tested, well-validated approaches, including cognitive-behavior therapy and mindfulness-based interventions.