HS Medical Treatments
From topical antibiotics and oral tetracyclines to FDA-approved biologics. Every medication category explained clearly - how they work, what to expect, and who they are for.
Last reviewed: March 2026
This guide is for educational purposes only. Always work with a dermatologist to determine the right treatment plan for your individual case. Do not start, stop, or change medications without medical supervision.
Treatment Categories
HS treatment follows a stepwise approach based on disease severity. Most patients use a combination of categories simultaneously. Click any category to expand the full medication list.
Antibiotics remain the cornerstone of first-line HS management. They reduce bacterial colonization and have direct anti-inflammatory effects independent of their antimicrobial activity.
Mild HS, localized lesions
Apply twice daily to affected areas. Most effective for superficial lesions and as adjunctive therapy.
Mild-to-moderate HS
100mg twice daily for 12 weeks. Anti-inflammatory effects beyond antimicrobial activity. Avoid in pregnancy.
Moderate HS, antibiotic-resistant cases
300mg each twice daily for 10-12 weeks. Strongest antibiotic regimen for HS. Monitor for C. difficile.
Mild-to-moderate HS
500mg twice daily. Alternative to doxycycline. Must be taken on empty stomach.
The HS Treatment Ladder
Treatment selection is guided by disease severity. Most patients progress through steps as needed, and many use multiple steps simultaneously.
| Step | Treatment | HS Stage | Evidence Level |
|---|---|---|---|
| Step 1 | Topical antibiotics + antiseptic washes | Stage I | Strong |
| Step 2 | Oral antibiotics (doxycycline, clindamycin/rifampicin) | Stage I-II | Strong |
| Step 3 | Hormonal therapy or retinoids | Stage I-II | Moderate |
| Step 4 | Biologic therapy (adalimumab, secukinumab, bimekizumab) | Stage II-III | Strong (FDA-approved) |
| Step 5 | Surgery (deroofing, wide excision) | Stage II-III | Strong |