How To Manage Your Hidradenitis Suppurativa (HS) Pain

Hidradenitis suppurativa (HS) is a chronic (long-term) inflammatory skin condition affecting up to 1% of people in the United States. In people with HS, blocked hair follicles cause inflammation and painful abscesses or lesions, usually around the armpits and groin.

Chronic and acute (sudden) pain is common with HS. There are two types of pain associated with HS: nociceptive (localized) and neuropathic (nerve) pain.

HS pain can affect a person’s quality of life, affecting their work, intimacy, and mental health. There are several ways to manage pain from HS, either at home or with your healthcare provider. 

Pain from hidradenitis suppurativa can be chronic or acute, and home management strategies, including over-the-counter (OTC) medications or lifestyle changes, can help.

Although these strategies don’t require medical supervision, your healthcare provider may have suggestions specifically tailored to your needs.

OTC Medications

The main OTC medications used for HS are nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) and Aleve (naproxen). Oral NSAIDs are considered particularly helpful for HS because they reduce pain by lowering inflammation. Topical NSAIDs like lidocaine patches or menthol ointments are also an option, but they may cause skin irritation.

You can also try pain relievers like Tylenol (acetaminophen) for mild HS pain. However, studies on pain management for HS have shown that NSAIDs are usually more effective because of their anti-inflammatory effects.

Before regularly taking any OTC medications, you should check with your healthcare provider—especially if you have any other existing health conditions—for proper dosage recommendations. If needed, your healthcare provider may be able to prescribe a stronger or more frequent dose. 

Lifestyle Changes

HS develops when inflammation blocks hair follicles. This blockage can lead to skin irritation and abscesses, which are painful, pus-filled pockets on the body.

Making the following lifestyle changes may help reduce irritation to the skin and hair follicles:

• Wear loose-fitting, breathable clothing
• Wash away sweat soon after exercise or exposure to hot environments
• Take more frequent showers to reduce flare-ups
• Avoid harsh cleaning or skin products, such as scented soaps and laundry detergents

Other lifestyle changes include avoiding smoking and maintaining the optimal weight you and your healthcare provider discussed. Smoking increases the chance of blocked hair follicles, and obesity may increase skin friction, sweating, and hormonal changes that influence HS.

Home management of HS is a great way to help reduce pain. However, you may need additional help from your healthcare provider to manage your symptoms, especially with flare-ups.

Medications for Acute Pain

There are several prescription medications used to help manage HS pain, and your provider may prescribe different medications based on the type of pain you have.

Nociceptive (localized) pain in HS tends to be acute and can feel gnawing, aching, or throbbing. Some prescription medications that may help with nociceptive pain include: 

• Prescription-strength NSAIDs, like Advil or Aleve
• Prescription oral medications like Voltaren (diclofenac) or Celebrex (celecoxib)
• Lidocaine patches
• Menthol cream 
• Steroid injections like intralesional triamcinolone

These medications reduce inflammation and can help prevent your brain from receiving pain signals from your skin.

Medications for Chronic Pain

Neuropathic (nerve) pain may result from chronic inflammation related to HS, which feels like burning, stinging, or stabbing. For neuropathic pain, your healthcare provider may prescribe you:

• Anti-seizure medications like Neurontin (gabapentin) or Lyrica (pregabalin)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs), like Effexor (venlafaxine), which primarily treat depression and anxiety
• Tricyclic antidepressants (TCAs) like Pamelor (nortriptyline), Norpramin (desipramine), or Amitid (amitriptyline)

These medications help reduce pain coming from your nerves. SNRIs and TCAs, in particular, can reduce nerve pain associated with HS. They can also lower anxiety and depression symptoms that are common in people with this condition. 

Antiobiotics

Although bacterial infections aren’t primary causes of HS, they can increase inflammation and worsen pain. If your healthcare provider suspects an infection in the HS lesions, they may prescribe antibiotics to help clear the infection and reduce pain. 

Surgery

People with HS may develop painful lesions and abscesses that produce pus and odors. In some cases, surgeries may be necessary to reduce acute HS pain caused by these lesions and abscesses. Your healthcare provider may recommend incision and drainage of these abscesses to help relieve pain. 

In addition to home remedies, medication, and surgery, complementary treatment approaches may be helpful for HS pain. Your healthcare provider may suggest these approaches alongside standard medical practices.

Acupuncture

Acupuncture is a medical treatment in which small needles are applied to specific points on the body to relieve pain. It has been beneficial for other conditions, such as chronic headaches and arthritis. 

Radiofrequency-based (RF) selective electrothermolysis, using microneedling or epilation acupuncture needles, is a possible treatment for HS symptoms. RF uses the electrical properties of the skin to deliver energy from heat through an insulated needle, which can help reduce the need to drain HS lesions.

Acupuncture has shown benefits for some people with HS, but more studies are necessary to better understand its potential effectiveness as a treatment option.

Therapy

Living with HS can significantly affect your quality of life, and many people with this condition may struggle with anxiety or depression associated with the pain, stigma, and feelings of negative self-worth. Therapy can provide support and help remind and assure you that HS is not contagious or related to poor hygiene.

A healthcare provider may recommend cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) in combination with treatments for HS.

Alpha Lipoic Acid (ALA)

Alpha lipoic acid (ALA) is an antioxidant the body naturally makes. As a dietary supplement, it’s typically used for diabetic nerve pain. ALA may also help reduce nerve pain associated with HS. 

Curcumin 

Curcumin comes from the rhizomes (underground stems) of turmeric plants and can be taken as an herbal supplement. It’s known to help reduce inflammation, which people with HS would benefit from. It may also lower the chances of cardiovascular (heart) events like a heart attack, which someone with HS is at a higher risk of having.

If you’re experiencing pain that interferes with your daily activities, speaking with your healthcare provider or a dermatologist (a doctor specializing in skin, hair, and nail conditions) about treatment options is a great next step.

It may be difficult to determine when your HS symptoms warrant a visit to a healthcare provider. HS symptoms can sometimes be similar to those of a skin infection. Knowing what symptoms call for an evaluation is key, especially since bacterial skin infections are fairly common in people with HS.

If you have any of the following symptoms along with your pain, seek help right away:

• Fever
• Rapidly worsening symptoms
• More pus drainage than usual
• Redness, warmth, or red streaks coming from the affected area 

Managing pain from hidradenitis suppurativa (HS) can involve home remedies, medical treatments, surgery, and complementary approaches like acupuncture or supplements.

OTC medications for mild pain can reduce inflammation and provide relief. Lifestyle changes such as wearing loose clothing and avoiding irritants help minimize flare-ups. For more severe pain, your healthcare provider may recommend prescription medications.

If you have HS and the pain is affecting your quality of life, reach out to your healthcare provider for personalized treatment options to help improve symptoms.