Table 2. Therapeutic modalities for HS.

HS: hidradenitis suppurativa

Treatment/management option	Mechanism of action	Pros	Cons
Lifestyle modifications [20-22]	Weight management to reduce pressure on affected areas. Wearing loose-fitting clothing to minimizes friction and irritation. Smoking cessation to reduce disease severity and progression.	Complementary to medical treatments, can help reduce flare-ups and improve the overall well-being, no associated side effects.	May not be sufficient as a standalone treatment; requires commitment and lifestyle changes.
Topical medications [23-26]	Antibacterial washes/soaps to reduce bacterial colonization and prevent infection. Topical antibiotics (e.g., clindamycin, erythromycin) to target local infections and reduce inflammation. Retinoids (e.g., tretinoin) to prevent blockage of hair follicles and reduce inflammation.	Easy to use and apply, may provide relief for mild cases or early stages of HS, few systemic side effects.	Limited efficacy in moderate to severe cases; may not fully eliminate symptoms. Some individuals may experience skin irritation or dryness.
Systemic antibiotics [5,27,28]	Antibiotics such as tetracyclines (e.g., doxycycline) or rifampicin to target bacterial overgrowth and reduce inflammation.	Effective in controlling infection and reducing inflammation, may provide long-term remission in some individuals, can be combined with other treatments for better outcomes.	May require prolonged courses of antibiotics; potential for antibiotic resistance; possible systemic side effects (e.g., gastrointestinal disturbances, photosensitivity).
Intralesional injections [33,34]	Corticosteroids (e.g., triamcinolone) injected directly into individual lesions to reduce inflammation and promote healing.	Effective in reducing pain, and inflammation, and promoting healing in localized lesions; can be used for acute flares or individual persistent lesions.	Only suitable for localized lesions; may cause temporary skin atrophy or hypopigmentation at the injection site. Limited long-term efficacy.
Systemic immunosuppressive therapy [31,32]	Oral retinoids (e.g., isotretinoin) to normalize keratinization and reduce inflammation. Biologic agents (e.g., adalimumab, infliximab) to target specific inflammatory pathways.	Can be effective in severe cases or those resistant to other treatments; may provide long-term remission. Biologic agents have shown promising results in clinical trials. Isotretinoin can address acne-like symptoms associated with HS.	Requires close monitoring and regular blood tests; potential for systemic side effects and interactions. Biologic agents can be expensive and may increase the risk of infections. Isotretinoin has teratogenic effects and requires contraception.
Surgical interventions [35]	Incision and drainage to relieve pain and remove pus from abscesses. Wide excision for surgical removal of affected skin and tissue. Laser therapy for ablation of affected tissue and hair follicles.	Can provide temporary or long-term relief in severe cases; may be necessary for recurrent or persistent abscesses. Laser therapy may help reduce hair follicle blockage.	Surgical interventions carry risks, such as infection, scarring, or wound-healing complications; may require multiple procedures. Lesions may recur after surgery.