What can be prescribed?
For a mild to moderate flare, options include clindamycin 1% put on the skin, a short single course of a tetracycline antibiotic taken by mouth (doxycycline or minocycline) used for its anti-inflammatory effect (to calm swelling), a compounded resorcinol cream (one specially made by a pharmacy), and over-the-counter antiseptic washes (washes that kill germs on the skin) plus short-term naproxen (naproxen for a short time) for pain. The pills and the compounded cream need the physician's drug safety review before they are offered.
Why won't you drain a boil or treat a spreading infection online?
A soft, fluctuant abscess (a pus-filled lump that feels squishy) needs incision and drainage in person (being opened and drained), and a spreading or necrotizing infection (an infection that destroys skin tissue) can become dangerous within hours. Photos of skin folds cannot reliably tell these apart, so any of these is sent to same-day in-person or emergency care instead of an online antibiotic.
Is this ongoing treatment for long-term hidradenitis?
No. This visit treats a single flare and never becomes ongoing long-term (chronic) treatment. Because hidradenitis is a lifelong disease that keeps coming back (relapsing), a repeat request for antibiotic pills within 12 months, or a flare that has already failed antibiotics (did not get better with them), is sent to in-person dermatology (a skin specialist) for longer-term options such as a biologic (a type of medicine that targets the immune system).
What if I am pregnant or trying to conceive?
The tetracycline antibiotics and the compounded resorcinol cream are avoided in pregnancy, possible pregnancy, breastfeeding, and while trying to conceive, so this visit routes those visits to in-person dermatology or OB/GYN for pregnancy-safe options.
How is this different from acne keloidalis nuchae or bumps at the back of the neck?
Hidradenitis suppurativa causes recurrent boils and nodules in skin folds, the armpits, groin, buttocks, and under the breasts. Firm, recurring bumps limited to the back of the neck or the occipital hairline are more likely acne keloidalis nuchae, which is treated differently. If your bumps are at the nape rather than in the skin folds, use that guide instead.
Read the acne keloidalis nuchae guide