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Treatment

HS Flare Treatment

When a flare hits, you need answers fast. This guide covers every treatment option, from what you can do at home tonight to the medications that can reduce flare frequency long-term.

Authoritative Resource

How to Manage HS Flares: Complete Guide

Step-by-step guidance on managing acute flares, preventing recurrence, and building a long-term flare management plan.

Read the Full Guide

An HS flare is not just a painful inconvenience, it can be debilitating, affecting your ability to work, sleep, and move freely. The good news is that there are more treatment options available today than ever before, ranging from simple home care to FDA-approved biologic medications that can dramatically reduce flare frequency.

The right treatment depends on your flare severity, your overall disease stage, and what has worked for you in the past. This guide walks through every option in order of escalation, so you can find the right starting point.

Always consult your dermatologist before starting or changing medications. This guide is for educational purposes and does not replace professional medical advice.

Immediate Steps When a Flare Starts

Do this right now:

  1. 1Apply a warm (not hot) compress to the area for 10–15 minutes. Repeat 3–4 times daily. Heat increases blood flow and can help an abscess drain naturally.
  2. 2Take an NSAID (ibuprofen 400–600mg or naproxen 220mg) to reduce pain and inflammation. Follow package directions.
  3. 3Gently cleanse the area with an antibacterial wash (chlorhexidine or benzoyl peroxide body wash) once daily. Do not scrub.
  4. 4Switch to loose-fitting, breathable clothing (cotton or moisture-wicking fabric) to minimize friction on the affected area.
  5. 5Avoid shaving the affected area until the flare resolves.

If you have a fever above 38.5°C (101.3°F), spreading redness (cellulitis), or severe pain that is not controlled by OTC medication, seek urgent medical care. These may indicate a spreading infection requiring IV antibiotics.

The HS Treatment Ladder

HS treatment follows a stepwise approach, starting with the least invasive options and escalating based on response. Below is a comprehensive overview of all available treatments organized by category.

Immediate Home Care

  • •Warm compresses (10–15 min, 3–4x daily)
  • •OTC NSAIDs (ibuprofen, naproxen)
  • •Gentle cleansing with antibacterial wash
  • •Loose-fitting, breathable clothing
  • •Zinc-based barrier creams to reduce friction

Prescription Topicals

  • •Clindamycin 1% solution or gel
  • •Resorcinol 15% cream (peeling agent)
  • •Topical retinoids (for comedones)

Oral Medications

  • •Doxycycline or minocycline (tetracyclines)
  • •Clindamycin + rifampicin combination
  • •Hormonal therapy (spironolactone, OCPs) for women
  • •Dapsone (for refractory cases)
  • •Metformin (for patients with insulin resistance)

In-Office Procedures

  • •Intralesional corticosteroid injection (fastest relief)
  • •Incision and drainage (I&D) for large abscesses
  • •Laser hair removal (reduces follicular triggers)
  • •CO2 laser or deroofing for sinus tracts

Biologic Therapies

  • •Adalimumab (Humira). FDA-approved
  • •Secukinumab (Cosentyx) , FDA-approved
  • •Bimekizumab (Bimzelx) , newer approval
  • •Infliximab (off-label)
  • •Ixekizumab (off-label)

Biologic Therapies: A Game-Changer for Severe HS

For patients with moderate-to-severe HS who have not responded to antibiotics and other treatments, biologic medications represent the most significant advance in HS care in decades. These injectable drugs target specific proteins in the immune system that drive HS inflammation.

Adalimumab (Humira)
Targets: TNF-alpha
FDA-approved 2015

First biologic approved for HS; weekly injections

Secukinumab (Cosentyx)
Targets: IL-17A
FDA-approved 2023

Monthly injections after loading dose

Bimekizumab (Bimzelx)
Targets: IL-17A & IL-17F
FDA-approved 2023

Dual IL-17 blockade; promising trial data

Biologics require prior authorization from insurance and are typically prescribed by dermatologists experienced in HS management. For more information on the latest treatment research, visit our Research page.

Long-Term Flare Prevention

Treating individual flares is only part of the equation. Long-term management focuses on reducing flare frequency and severity through a combination of medical treatment and lifestyle modification.

Track Your Triggers

Use our free Flare Tracker tool to log flares, identify patterns, and pinpoint your personal triggers.

Anti-Inflammatory Diet

Dietary changes, particularly reducing dairy and high-glycemic foods , can meaningfully reduce flare frequency.

Stress Management

Psychological stress is a well-documented HS trigger. Mindfulness, therapy, and sleep hygiene all play a role.

Specialist Care

Regular follow-up with an HS-experienced dermatologist is essential for adjusting your treatment plan as your disease evolves.

Frequently Asked Questions

How long does an HS flare last?
An HS flare can last anywhere from a few days to several weeks, depending on severity and treatment. Mild nodules may resolve in 7–14 days. Abscesses that rupture and drain often take 2–4 weeks to heal. Without treatment, some flares can persist for months, particularly if sinus tracts are involved.
What is the fastest way to calm an HS flare?
For immediate relief, applying a warm compress for 10–15 minutes several times a day can help bring an abscess to a head and reduce pain. Intralesional corticosteroid injections (given by a dermatologist) are the fastest medical intervention, they can reduce inflammation within 24–48 hours. Over-the-counter NSAIDs like ibuprofen help with pain and inflammation.
Should I pop or squeeze an HS lesion?
No. Squeezing or popping HS lesions is strongly discouraged. It does not remove the underlying infection, can push bacteria deeper into the tissue, increases the risk of spreading infection, and worsens scarring. If a lesion needs to be drained, this should be done by a medical professional using sterile technique.
What antibiotics are used for HS flares?
Topical clindamycin is commonly prescribed for mild HS. For moderate-to-severe flares, oral antibiotics such as doxycycline, minocycline, or the combination of clindamycin plus rifampicin are used. Long-term antibiotic therapy is sometimes needed for disease control, though resistance is a concern with prolonged use.
Can biologics stop HS flares?
Yes. Adalimumab (Humira) and secukinumab (Cosentyx) are FDA-approved biologics for moderate-to-severe HS. They work by blocking inflammatory proteins (TNF-alpha and IL-17A respectively) that drive HS flares. Many patients experience a significant reduction in flare frequency and severity within 12–16 weeks of starting biologic therapy.
What foods should I avoid during an HS flare?
Many HS patients report that dairy products, high-glycemic foods (white bread, sugary drinks), brewer's yeast, and nightshade vegetables can trigger or worsen flares. An elimination diet under medical supervision can help identify your personal food triggers. See our full guide on HS diet and inflammation for more details.

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Medical References

  1. [1]Alikhan A, et al. North American clinical management guidelines for hidradenitis suppurativa. J Am Acad Dermatol. 2019;81(1):76-90. PubMed
  2. [2]Zouboulis CC, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619-644. PubMed
  3. [3]Jemec GBE. Hidradenitis suppurativa. N Engl J Med. 2012;366(2):158-164. PubMed