Hidradenitis Suppurativa Flare Management: a Review of Medical and Procedural Strategies

Abstract Purpose of Review While flares are a well-recognized feature of hidradenitis suppurativa (HS), defining flares and selecting an appropriate management strategy can be challenging. This narrative review discusses approaches to HS flare identification and management, highlighting both preventive and therapeutic strategies. Recent Findings For decades, topical and systemic antibiotics have been a mainstay of HS flare treatment due to their anti-inflammatory properties and quick onset. According to a 2024 survey of HS experts, trimethoprim-sulfamethoxazole and amoxicillin-clavulanate were the second and third most prescribed antibiotic monotherapy following tetracyclines, respectively. Preliminary evidence suggests that pairing amoxicillin-clavulanate with a prednisone taper may have potential for gaining rapid control of HS flares. Among topical treatments, clascoterone and ruxolitinib emerge as promising non-antimicrobial options for mild to moderate HS. Procedural strategies for flare management include intralesional steroids for acutely inflamed nodules or tunnels and punch incision and drainage for relief of painful abscesses. A survey study of 900 individuals with self-reported HS found that complementary and alternative medicine (CAM) interventions are perceived to be one of the most helpful tools for flare management. Summary Flares have significant implications for the quality of life in patients with HS. In order to synergize anchor therapy of baseline disease with prompt control of flare activity, a multimodal approach of medical, procedural, and CAM interventions combined with trigger avoidance and patient education is critical.