TL;DR
The best hidradenitis suppurativa treatments depend on your Hurley stage. For mild disease (stage I) and some stage II, a prescription topical like clindamycin plus resorcinol is a reasonable first step. For moderate to severe HS, biologics (adalimumab, secukinumab, bimekizumab), oral antibiotics, and procedures usually work better and need an in-person dermatologist.
The best hidradenitis suppurativa treatments are not the same for everyone, because HS ranges from a few recurring bumps to deep, connected tunnels that need medical or surgical care. This list is ranked by how early in the disease each option makes sense, not by a single "winner." If you only want to compare creams and washes, see our guide to the best topical treatment for hidradenitis suppurativa.
How do doctors stage hidradenitis suppurativa?
Most dermatologists use the Hurley system. It sorts HS into three stages, and your stage points toward the right treatment.
- Stage I: single or multiple abscesses with no tunnels or scarring. Usually mild.
- Stage II: recurrent abscesses with tunnels (sinus tracts) and scarring, in one or more areas. Moderate.
- Stage III: widespread, connected tunnels and abscesses across an area. Severe.
Honest note: topicals are mainly for stage I and some stage II HS. If you have deep painful nodules, draining tunnels, or scarring that keeps spreading, you likely need a biologic or a procedure, and that means seeing a dermatologist in person.
What are the best treatments for hidradenitis suppurativa, ranked?
| Rank | Treatment | Best for | Prescription? |
|---|---|---|---|
| 1 | Vuret HS Flare Control Cream | Mild HS, early flares | Yes (compounded) |
| 2 | Topical clindamycin 1% | Mild HS, pustules | Yes |
| 3 | Benzoyl peroxide or chlorhexidine wash | Prevention, mild HS | OTC or Rx |
| 4 | Oral antibiotics | Mild to moderate HS | Yes |
| 5 | Adalimumab (Humira) | Moderate to severe HS | Yes (FDA-approved) |
| 6 | Secukinumab, bimekizumab | Moderate to severe HS | Yes (FDA-approved) |
| 7 | Steroid injections | Single painful nodules | In-office |
| 8 | Surgery | Tunnels, scarring, stage II to III | In-office |
1. Vuret HS Flare Control Cream: a prescription topical for mild HS
Best for: stage I HS and mild stage II, or as an add-on to other care.
This is a compounded cream with resorcinol 15% and clindamycin 1%. Clindamycin targets bacteria, and resorcinol is a keratolytic that helps loosen plugged follicles. A U.S.-licensed physician reviews your online visit and decides whether it fits. Compounded medications are not FDA-approved. Learn more on the HS Flare Control Cream page.
- Pros: no insurance needed, no waiting room, two ingredients in one cream, applied only where you flare.
- Cons: will not reach deep nodules or tunnels, may irritate skin, results vary.
2. Topical clindamycin 1%: the standard first-line antibiotic
Best for: mild HS with small pustules and inflamed bumps.
Clindamycin 1% is the most commonly prescribed topical for mild HS. See our clindamycin for hidradenitis suppurativa guide for how it works and its limits.
- Pros: inexpensive, widely covered by insurance, familiar to most doctors.
- Cons: research is limited, and long-term use alone can promote antibiotic resistance.
3. Benzoyl peroxide or chlorhexidine wash: the daily habit
Best for: people who get frequent surface flares in the armpits, groin, or under the breasts.
- Pros: cheap, available over the counter, lowers surface bacteria, pairs well with clindamycin.
- Cons: benzoyl peroxide can bleach fabric and dry skin. It does not treat deep lesions.
4. Oral antibiotics: the step up for moderate flares
Best for: widespread mild disease or stage II HS.
Doctors often use a tetracycline such as doxycycline for several months. For tougher cases, clindamycin plus rifampin is a common combination.
- Pros: treats a wider area than a cream, anti-inflammatory effect beyond killing bacteria.
- Cons: stomach upset, sun sensitivity, resistance concerns, and flares often return after stopping.
5. Adalimumab (Humira): the first FDA-approved HS biologic
Best for: moderate to severe HS.
Adalimumab blocks TNF-alpha, an inflammatory signal that is high in HS. It was approved for HS in 2015 and is given by injection.
- Pros: FDA-approved for HS, studied in large trials, can reduce nodules and abscesses.
- Cons: expensive, needs prior authorization, raises infection risk, and not everyone responds.
6. Secukinumab (Cosentyx) and bimekizumab (Bimzelx): newer biologics
Best for: moderate to severe HS, especially when adalimumab has not worked.
Both block interleukin-17 pathways and are FDA-approved for HS. Ask your dermatologist which one fits your history.
- Pros: a different target than adalimumab, so a second route if the first fails.
- Cons: cost, injections, and possible yeast infections or other side effects.
7. Intralesional steroid injections: fast relief for one angry nodule
Best for: a single inflamed, painful lump.
- Pros: can calm a nodule within days.
- Cons: in-office only, does not stop new lesions, can thin the skin if repeated.
8. Surgery (deroofing and excision): for tunnels and scarring
Best for: stage II and III disease with tunnels that keep coming back in the same spot.
- Pros: can remove the diseased tissue for good in that area.
- Cons: real recovery time, scarring, and new HS can appear elsewhere.
Which hidradenitis suppurativa treatment should I start with?
If your HS is mild and you are early in the process, a topical plus a daily wash is a sensible start. If you have had more than a couple of flares a month, tunnels, or scars, skip ahead to a conversation about biologics or procedures. Weight management, quitting smoking, and loose clothing can also reduce flares at any stage.
Get seen in person quickly if an abscess comes with fever, spreading redness, or severe pain. HS can also be mistaken for other conditions, so read our comparison of hidradenitis suppurativa vs boils if you are not sure what you have.
Can I start with an online visit?
For mild HS, yes. If you want to see whether a topical fits, you can start an online visit for the Vuret HS Flare Control Cream. A physician reviews your history, you are charged for medication only if approved, and it ships discreetly. For anything beyond mild disease, the doctor will likely tell you to see a dermatologist in person.
More background is available from the American Academy of Dermatology and Mayo Clinic.
HS Flare Control Cream: Resorcinol 15% + Clindamycin 1%
A prescription cream that pairs resorcinol 15% with clindamycin 1%, applied right where flares start. Prescribed online by a U.S.-licensed physician only if it is right for you. Compounded medications are not FDA-approved.
See HS Flare Control CreamFrequently asked questions
What is the most effective treatment for hidradenitis suppurativa?
For moderate to severe HS, biologics such as adalimumab, secukinumab, and bimekizumab have the strongest evidence, and surgery can remove persistent tunnels. For mild HS, topical clindamycin-based treatment and antiseptic washes are the usual starting point.
Can hidradenitis suppurativa be cured?
There is no known cure for HS. Treatment aims to reduce flares, control pain, and prevent scarring, and many people get long stretches of improvement with the right plan.
Do topical creams work for hidradenitis suppurativa?
They may help with mild disease (Hurley stage I) and some stage II, mainly by reducing surface bacteria and clogged follicles. They generally do not reach deep nodules or tunnels, so moderate to severe HS usually needs oral or injectable treatment.
When should I see a dermatologist in person for HS?
See one if you have tunnels, scarring, flares more than a few times a year, or lesions in several areas. Seek care right away for fever, rapidly spreading redness, or severe pain around an abscess.
Are the biologics for HS safe?
They are FDA-approved for HS, but they affect the immune system and can raise infection risk. Your dermatologist will screen you first, for example for tuberculosis, and monitor you while on treatment.
Is the Vuret HS cream FDA-approved?
No. It is a compounded medication made in a licensed U.S. 503A pharmacy, so it is not FDA-approved. A physician decides whether it is appropriate for you.
Disclosure: Vuret makes the HS Flare Control Cream featured on this page, so we have a financial interest in it. We still list real alternatives, including when another option may suit you better. This article is educational and is not a substitute for advice from your own doctor.