Hidradenitis suppurativa is a chronic (long-term) inflammatory disease. “It can be extremely painful,” says Anthony Fernandez, MD, PhD, a dermatologist at Cleveland Clinic in Ohio. HS has been linked to other chronic conditions also, including:
ObesitySevere acneInflammatory bowel diseaseArthritisDiabetesCardiovascular diseaseInflammatory arthritisMetabolic syndrome
It’s important to talk to your doctor if you think you have HS. They may prescribe medications, such as corticosteroids or biologics, to help reduce inflammation and prevent breakouts. “As the disease becomes more severe, you’re likely to need immune-modifying therapy, as HS is primarily due to underlying immune dysregulation,” explains Shawn Kwatra, MD, an associate professor of dermatology at Johns Hopkins University School of Medicine in Baltimore. Your healthcare provider may also recommend surgical treatment, such as laser surgery, deroofing, or excision for lesions that grow deep into the skin. Aside from medical treatments, losing weight is one of the most important steps you can take to manage HS, according to the American Academy of Dermatology (AAD), as well as help lower your risk of heart disease and diabetes. If you’re a smoker, quitting may reduce the frequency and severity of HS flare-ups. Another important way you can help manage HS is to follow a regular skin-care routine. Here are seven dermatologist-approved skin-care tips to help keep your HS in check.
1. Use an antiseptic cleanser.
A variety of bacteria live throughout the body, including in hair follicles, which, with HS, often get clogged and burst. This releases bacteria into underlying skin and activates the immune system, says Dr. Fernandez. Using an antiseptic or antimicrobial wash in areas prone to HS can help limit flares by minimizing bacterial overgrowth, which helps when hair follicles rupture. “Less bacteria are extracted, so the immune system doesn’t have that much to be angry about,” explains Fernandez. He recommends cleansers with 4 percent chlorhexidine gluconate, an ingredient that’s often part of an antiseptic solution used by surgeons. Start by using an antiseptic or antimicrobial cleanser on your entire body once a week. If it works well without irritating your skin, you can up the frequency to once per day.
2. Try over-the-counter acne medications.
Nonprescription antiseptic washes containing benzoyl peroxide, typically used to treat acne, can also be effective for inflammatory skin conditions such as HS. They work by decreasing the total bacteria count on the skin’s surface. Dr. Kwatra also suggests zinc pyrithione washes, which are often used to treat scalp psoriasis and acne. “It may be helpful, as zinc has anti-inflammatory properties,” he says.
3. Don’t scrub your skin.
“Hidradenitis suppurativa is not caused by poor hygiene,” says Fernandez, so excessive cleansing is unlikely to be helpful. “[Scrubbing] is one of the worst things to do, because we think trauma can precipitate flares,” he adds. Even so, there’s no consensus about whether using loofahs, brushes, or washcloths is harmful for people with HS. It may be fine to use them gently, but steer clear of HS lesions. Scrubbing these areas will do more harm than good by further irritating already inflamed skin.
4. Skip thick creams and ointments.
Choose antimicrobial washes and light moisturizers rather than thicker over-the-counter creams and ointments. “The cream base itself can get in hair follicles and further plug them, which can aggravate HS over time,” says Fernandez. If you can’t find a moisturizer that suits you, ask your dermatologist to recommend one. You might also want to talk to them about prescribing a topical antibiotic for affected areas. “We often recommend prescription clindamycin and clindamycin with benzoyl peroxide,” says Kwatra.
5. Remove hair between HS breakouts.
Shaving or waxing between flares may help prevent active HS lesions by keeping hair follicles from getting clogged, says Fernandez. If you’re in the middle of a flare, though, it’s advisable not to shave, as doing so can cause trauma and inflammation to the area and make HS lesions worse, according to the AAD. Your dermatologist can recommend hair removal options, one of which may be with a laser. Studies have shown laser hair removal can improve HS symptoms by 32 to 72 percent. “It’s found to be quite helpful, given the hair follicle seems to be the primary anatomical structure involved in HS,” says Fernandez. But laser hair removal can be pricey, and you’ll have to pay for it out of pocket. Keep in mind, too, it may not be an option if you have advanced HS, as lasers can’t penetrate areas with a lot of scar tissue.
6. Keep skin sweat free, especially in areas prone to HS.
Bacteria thrive in moist, warm environments, which is why hair follicles in the armpits become clogged and inflamed so easily in people with HS. If sweating makes HS worse for you, an antiperspirant can help. Choose an unscented, hypoallergenic one to lower the risk of an allergic reaction to fragrances or other additives. You can also try applying talc-free, hypoallergenic powder to areas where you tend to sweat a lot. Loose-fitting clothing can keep you cool all over and help prevent sweating in other parts of your body. Tight clothes can aggravate HS by rubbing against areas prone to inflammation and lesions, clogging hair follicles and causing trauma to the skin, says Fernandez. (One exception: Compression shorts and other skin-hugging clothing made of moisture-wicking material are best for exercise when you have HS, as they prevent skin-on-skin friction during movement.) If sweating is especially challenging for you, talk to your doctor. Prescription antiperspirants, oral medications, and even Botox can help decrease the amount of perspiration you produce.
7. Consider bleach baths.
If other measures don’t control your HS well enough, talk to your dermatologist about taking 5- to 10-minute bleach baths, a tactic often recommended for atopic dermatitis, or eczema, to help decrease the amount of bacteria on your skin. This doesn’t mean submerging your body in full-strength bleach though. The American Academy of Allergy, Asthma & Immunology advises adding a quarter- to half-cup of 5 percent bleach to a full tub of water (40 gallons) and soaking your torso or inflamed areas for about 10 minutes, no more than twice a week. Ask your dermatologist to fine-tune this formula for you before you take a dip, as using too much bleach can break down the skin barrier and cause more problems, says Fernandez. It’s a good idea to see your healthcare provider or dermatologist regularly if you have HS. Don’t hesitate to ask if there any new medicines or skin-care tactics for treating lesions or preventing flares. Hidradenitis suppurativa is a disease that’s been ignored for decades, says Fernandez, “but our understanding of HS is evolving rapidly.”
