Topical Treatments for Hidradenitis Suppurativa

Key Takeaways

• Antiseptic cleansers for hidradenitis suppurativa (HS) may reduce odor, drainage, and superinfection risk, despite limited high-level evidence.
• Topical clindamycin 1% remains the only well-studied topical antibiotic for HS; combining with benzoyl peroxide may reduce antimicrobial resistance risk.
• Resorcinol 15% demonstrates meaningful reductions in lesion size, pain, and HiSCR response rates, representing a non-antibiotic alternative for flare or field therapy.
• Short-term topical corticosteroids may help manage localized flares, but prolonged use is discouraged due to atrophy and striae risk in intertriginous areas.

Topical therapies are an important component of hidradenitis supportive (HS) management and may sufficiently control milder, very early, or localized disease. In moderate-to-severe HS, topical agents work best when used as adjuncts to systemic therapy such as biologics, hormonal or metabolic modulators, and/or antibiotics. Topical therapies can provide benefit by reducing bacterial burden, decreasing inflammation, and providing symptomatic relief from minor localized flares. 

ANTISEPTIC WASHES 

Antimicrobial cleansers can be helpful for minimizing bacterial load on the skin, preventing superinfection of active HS lesions, and reducing odor. Although antiseptic washes have not been rigorously studied for HS, the use of chlorhexidine, benzoyl peroxide, and zinc pyrithione are supported by expert opinion.¹ Sodium hypochlorite body wash is an alternative agent with a recent study of 165 participants showing decreased pain, drainage, and odor when used daily.² Patients should be advised to apply these agents to their HS-affected areas once daily when showering as tolerated; gently lathering and leaving the wash on for 3 to 5 minutes before rinsing can be helpful. Some patients may prefer to have a rotating schedule for different washes.

ANTIBIOTICS 

To date, clindamycin 1% is the only topical antibiotic that has been studied for HS.^3,4 Patients should be directed to apply a thin layer to active HS areas once to twice daily. It is important for clinicians to consider a topical’s vehicle when prescribing to optimize tolerability and adherence. Formulations with high alcohol contents, such as gels and solutions, can cause stinging when applied to open or ulcerated lesions, making the lotion formulation a more tolerable option for many patients. Combining topical clindamycin use with a benzoyl peroxide wash may help lower the risk of developing antimicrobial resistance. Topical mupirocin, erythromycin, gentamicin, or dapsone can be considered for patients who are unable to tolerate clindamycin. 

RESORCINOL 

Resorcinol (1,3-dihydroxybenzene), a phenolic compound commonly used in chemical peels, is a non-antibiotic topical that has keratolytic, anti-inflammatory, and antimicrobial properties. Across a cohort of 32 patients with HS, resorcinol 15% twice daily was found to reduce the clinical size of HS lesions and associated pain as early as 7 days after application.⁵ A more recent study suggests that clinical response as measured by Hidradenitis Suppurativa Clinical Response (HiSCR) (at least 50% reduction from baseline in the total abscess and inflammatory nodule count, without increase in the number of abscesses or draining sinus tracts) was significantly higher in patients treated with resorcinol 15% twice daily (85.3%, n = 61) compared to those treated with clindamycin 1% twice daily (53%, n = 73).⁶ It is an attractive alternative to topical antibiotics, especially with rising concerns regarding antibiotic resistance, and can be used either as a spot treatment at first onset of flare or as field therapy to broader areas with activity. It is important to counsel patients on the potential for skin burning, irritation, and peeling. Patients should be advised to use cautiously in sensitive areas such as the vulvar or perianal regions. Resorcinol 15% must be ordered through a compounding pharmacy. 

CORTICOSTEROIDS

Evidence for use of topical steroids in HS is limited and is largely extrapolated from other inflammatory conditions. Both intralesional and systemic corticosteroids have demonstrated benefit for active HS lesions across a small number of case reports and series.^7,8 Thus, topical corticosteroids may be helpful short-term as a spot treatment for managing localized and acute flares due to their anti-inflammatory effects. Continuous or maintenance topical steroid use for HS is not advised due to risks of striae, atrophy, and telangiectasias, especially in intertriginous regions.

EMERGING TOPICAL AGENTS 

It is an exciting time for the HS community as there is a growing pipeline of not only systemic but also topical therapies for the management of HS. Topical ruxolitinib 1.5% cream, a selective JAK1/2 inhibitor approved for atopic dermatitis (AD) and vitiligo, is currently being evaluated for mild-to-moderate HS in Phase 3 trials (TRuE-HS 1 and 2) after showing significant reductions in abscess and inflammatory nodule (AN) counts in Phase 2 studies when applied twice daily.9 Clinicians may consider recommending this off-label, especially in patients with co-morbid AD or vitiligo. 

Clascoterone 1% cream, a topical androgen receptor inhibitor, is currently approved for acne vulgaris. Preliminary data from a cohort of 12 HS patients suggests potential benefit, with 83% (n = 12) reporting improvement in flare frequency, lesion size, and erythema after 12 weeks of twice daily clascoterone 1% cream.¹⁰ Larger studies and randomized clinical trials are needed to fully elucidate the efficacy and safety of clascoterone for HS. 

Roflumilast 0.3% topical is another emerging treatment for HS, with recruiting currently ongoing for a phase 2 open label study. There was a recently published case series of 3 patients with Hurley I HS (baseline total abscess/inflammatory nodule count of 2, 2, and 6) who were given topical roflumilast 0.3% to apply to affected HS sites once daily, continuing even in the absence of active flares. Two patients had no nodules, abscesses, pain, or itch at 1 month, and one patient achieved the same at 2 months.¹¹

OTC AND CAM AGENTS 

Over-the-counter (OTC) and complementary and alternative (CAM) topical agents are commonly used among the HS patient community. Topical lidocaine can be purchased OTC and some patients may find it helpful for pain relief. A recent study of 50 patients who applied strontium cream found a significant reduction in HS-associated itch after 1 week of application.¹² Based on an anonymous survey study of more than 250 HS patients, commonly used CAM products included turmeric/curcumin (which can be made into or purchased in paste form), magnesium sulfate baths, and cannabidiol (CBD) oil.¹³ Anecdotally, some patients report benefit from other topicals including aloe vera, camphor, menthol, and other commercially available herbal or compounded topical products. 

CONCLUSION

Topical agents are generally well tolerated and easy for patients to use, and they continue to play a key role in the management of HS. They should be leveraged not only in milder disease but also as adjunctive therapies in moderate-to-severe cases. The growing landscape of topical therapies being investigated and the possibility of a US Food and Drug Administration (FDA)-approved topical therapy for HS in the not-to-distant future offer the exciting potential to enhance future HS management. 

1. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101. https://doi.org/10.1016/j.jaad.2019.02.068

2. Omole I, Brooks B, Pham T, Chovatiya R, Daveluy S. Real-world efficacy of sodium hypochlorite body wash in managing hidradenitis suppurativa. J Clin Aesthet Dermatol. 2025;18(8):13-15.

3. Clemmensen OJ. Topical treatment of hidradenitis suppurativa with clindamycin. Int J Dermatol. 1983;22(5):325-328. https://doi.org/10.1111/j.1365-4362.1983.tb02150.x

4. Jemec GB, Wendelboe P. Topical clindamycin versus systemic tetracycline in the treatment of hidradenitis suppurativa. J Am Acad Dermatol. 1998;39(6):971-974. https://doi.org/10.1016/S0190-9622(98)70272-5

5. Pascual JC, Encabo B, Ruiz de Apodaca RF, Romero D, Selva J, Jemec GB. Topical 15% resorcinol for hidradenitis suppurativa: an uncontrolled prospective trial with clinical and ultrasonographic follow-up. J Am Acad Dermatol. 2017;77(6):1175-1178. https://doi.org/10.1016/j.jaad.2017.07.008

6. Molinelli E, Brisigotti V, Simonetti O, et al. Efficacy and safety of topical resorcinol 15% as long-term treatment of mild-to-moderate hidradenitis suppurativa: a valid alternative to clindamycin in the panorama of antibiotic resistance. Br J Dermatol. 2020;183(6):1117-1119. https://doi.org/10.1111/bjd.19337

7. Salvador-Rodríguez L, Arias-Santiago S, Molina-Leyva A. Ultrasound-assisted intralesional corticosteroid infiltrations for patients with hidradenitis suppurativa. Sci Rep. 2020;10(1):13363. https://doi.org/10.1038/s41598-020-70176-x

8. Wong D, Walsh S, Alhusayen R. Low-dose systemic corticosteroid treatment for recalcitrant hidradenitis suppurativa. J Am Acad Dermatol. 2016;75(5):1059-1062. https://doi.org/10.1016/j.jaad.2016.06.001

9. Porter ML, Ferreira-Cornwell MC, Wang M, Nawaz H, Gooderham MJ. Efficacy and safety of ruxolitinib cream in patients with mild to moderate hidradenitis suppurativa: results from a randomized, double-blind, vehicle-controlled phase 2 study. J Am Acad Dermatol. Published online November 15, 2025. https://doi.org/10.1016/j.jaad.2025.10.149

10. Hargis A, Yaghi M, Maskan Bermudez N, Lev-Tov H. Clascoterone in the treatment of mild hidradenitis suppurativa. J Am Acad Dermatol. 2024;90(1):142-144. https://doi.org/10.1016/j.jaad.2023.08.064

11. Adusumilli NC, Zarabian N, Farah M, Murphy EC, Friedman AJ. Topical roflumilast 0.3% cream for mild hidradenitis suppurativa: a prospective case series. JAAD Case Rep. Published online December 2025. https://doi.org/10.1016/j.jdcr.2025.12.016

12. Walker R, Brooks B, Daveluy S. Efficacy of strontium cream in alleviating pruritus in hidradenitis suppurativa. J Clin Aesthet Dermatol. 2025;18(3):12-14.

13. Price KN, Thompson AM, Rizvi O, et al. Complementary and alternative medicine use in patients with hidradenitis suppurativa. JAMA Dermatol. 2020;156(3):345. https://doi.org/10.1001/jamadermatol.2019.4595

Katrina H. Lee, MD 

• Assistant Professor of Dermatology
• Keck School of Medicine, University of Southern California