Topical Clindamycin (antibiotic) is commonly prescribed as a first course of treatment, and is well documented in clinical studies as having a good response rate and is well tolerated by most patients.
Topical steroids are also a very common first line of treatment, and can be used to calm small localised flaring abscesses. Steroid can cause certain side effects such as thinning of the skin, so should always be used sparingly, and for short periods. Examples of such steroid creams are Dermovate, Eumovate and Betnovate.
Antimicrobial washes such as Hibiscrub, Hibiclens and Octenisan are often given to ensure that the open wounds are kept clean, and although these will not help to treat the condition, they will help to prevent any secondary infection that may prevent the wound healing.
The most common antibiotics prescribed to treat HS are used for their anti inflammatory properties rather than to treat infection.
The most effective treatment for HS is a combination of Rifampicin and Clindamycin which is given for 2-3 months. This will bring about a remission in at least three quarters of patients. This remission can be long lasting and further relapses can be treated in the same way. A blood test to monitor liver function is usually performed at the start of treatment and again after one month. Side effects are usually minimal but include nausea, vomiting and diarrhoea [which can occasionally be severe].
Other anti-inflammatory antibiotics such as erythromycin, oxytetracycline, minocycline and lymecycline are sometimes used in courses of at least three months. They are effective to some extent but are gradually being replaced by Rifampicin and Clindamycin.
Flucloxacillin, amoxicillin, co-amoxiclav and Penicillin V are often used to treat HS. They all belong to the penicillin family and are useful for treating secondary infections such as cellulitis, but are not effective when used alone. Common side effects include nausea, vomiting and diarrhoea. Some people can have allergic reactions to penicillin based drugs. They may also reduce the effectiveness of the oral contraceptive pill.