Hidradenitis suppurativa (HS) is an inflammatory skin disease that causes pimple-like bumps to form under the skin. These nodules usually appear in areas with apocrine sweat glands, such as the armpits and groin. They may also show up in places where skin rubs together, like the buttocks, waist, inner thighs, anus, and under the breasts.
The cause of HS isn’t fully understood, but experts think it’s an overactive immune response. Proteins and other substances on your skin can clog your hair follicles. Sometimes, this blockage traps bacteria inside the follicle. A nodule can form if this clog, or the rupture of the blocked follicle, causes an inflammatory response.
Here are some tips for managing your HS.
Personal hygiene
Using the proper products to wash and clean your skin is important to managing pain and prevent flares.
Best cleansers to use
When you shower, use a soap-free wash like Cetaphil. Gentle cleansers that are fragrance-free, dye-free, and soap-free are your best bet for preventing further skin irritation. Apply body washes with your hands. Products like washcloths and loofahs can irritate sensitive tissue.
Bleach baths can also help remove certain bacteria from your skin. This should be done at home using the directions provided by your dermatologist.
Odor control
For odor, apply antibacterial products to problem areas. To reduce breakthrough odor, try a body wash or acne wash that lists “antibacterial” on its label. Follow up with an OTC antibiotic cream like Neosporin at sites that drain.
Shaving
Some people report that shaving in the middle of a flare worsens their breakouts. However, the evidence against shaving is weak, and more recent research on its impact on HS is needed.
If you’re concerned about hair removal, talk with your dermatologist. They may suggest methods that are less likely to irritate your skin.
When you’re away from home
You should always carry hand sanitizer and wipes. This is a good way to keep your skin fresh when you’re not home.
Wardrobe
The clothing you choose can make a big difference in your comfort level and confidence during a breakout.
Loose-fitting clothing
Some people with HS find that tight clothing rubs affected areas and makes breakouts worse.
To help air circulate and keep your skin dry, you can wear loose-fitting clothing made of natural fibers like cotton or hemp. Opt for stretchy pants like leggings or yoga pants since they provide more give and allow for freer movements.
Nonrestrictive underwear
Since nodules often appear in these areas, underwire and elastic bands may be uncomfortable. Look for soft-cupped bras and underwear designs without elastic at the legs.
Breathable layers
It may help to layer up, too. Sometimes draining nodules can stain clothing. Wearing a breathable base layer underneath whatever you’re wearing will prevent you from feeling anxious about staining your outfit. Of course, it’s always a good idea to pack a change of clothes just in case.
Gentle laundry detergents
Wash your clothing using detergents for sensitive skin. Look for laundry detergents without dyes, perfumes, or enzymes.
At-home pain relief
There are many options for easing the discomfort of HS at home using both traditional and integrative methods. They include:
Over-the-counter (OTC) pain relievers
Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can ease pain and inflammation associated with HS. Numbing ointments, such as lidocaine, may also help with the discomfort of breakouts.
Supplements
Turmeric contains the substance curcumin, which reduces inflammation. Steep a spoonful in hot water for tea or mix with a carrier oil, such as coconut oil, to apply directly to tender areas.
You may also consider adding a zinc supplement to your daily regimen. More evidence is needed, but research suggests zinc can reduce inflammation and aids in wound healing.
Compresses
A warm compress can help to reduce the swelling and inflammation of an HS lesion when applied directly. Try using dry heat from a heating pad or hot-water bottle at the site of a nodule to reduce pain. If dry heat isn’t available, you can use a steeped tea bag or warm washcloth at the site.
Cold compresses may provide relief for localized pain. Some people prefer pain relief from cold baths, cold wraps, or even ice at the tender site.
Diet
Eating a well-balanced diet is fundamental to your health and well-being. If you’re living with HS, it’s important to know which foods to eat and avoid to manage pain and prevent breakouts.
Eating anti-inflammatory foods can help minimize flares. These include oily fish, fresh fruits and vegetables, and healthy fats like those found in nuts. If you have a sweet tooth, chocolate and cinnamon make a good inflammation-fighting dessert combo.
According to small studies, dairy has been known to worsen HS symptoms. Also, people with a wheat intolerance should avoid brewer’s yeast as well as wheat, since these ingredients may cause an immune response. These ingredients are typically found in bread products and fermented products, including beer, wine, vinegar, and soy sauce.
It’s also important to note that if you’re living with HS and you currently smoke, you should consider quitting. Research suggests that weight loss may also help to reduce symptoms in people who are overweight.
Medically treating HS
Currently, there’s no cure for HS. But with the right treatment plan and lifestyle adjustments, you can learn to manage your symptoms and enhance your quality of life.
The goals of treatment for HS are to clear up active flares, reduce scars and tunnels, and prevent future breakouts. Some options are:
- Medication prescribed by a healthcare professional. These include antibiotics, corticosteroids, hormone therapy like birth control, and drugs used to treat conditions related to your immune system, including biologics.
- Light, laser, and energy sources to clear up lesions. These treatments are less common and stronger evidence of their effectiveness is needed, but they may reduce breakouts for some people with moderate to severe disease. The most effective of these is the Nd:YAG laser.
- Wound dressing for tunnels. Since HS causes lesions to form under your skin, your doctor may use dressings to help the areas heal.
- Surgery for very serious or painful flares. In some circumstances, your doctor may recommend surgery to laser, drain, or remove very deep or painful nodules or severe tracts that may be causing infection.
There are also lifestyle steps you can take to help manage HS. These are an important part of your journey to healing and should be done in combination with whatever treatment plan your doctor prescribes.
When to see a doctor
HS usually begins with one painful lump that lasts for weeks or months. After that, symptoms may be mild and restricted to one area. Or, symptoms may worsen and affect multiple areas.
Check with your doctor if you experience bumps under your skin that:
- are painful
- persist for weeks
- clear up and then return
- appear in multiple places
Takeaway
HS is a chronic skin condition characterized by painful nodules. To help you reduce the number of flares and ease your symptoms during breakouts, your treatment plan should include a combination of prescribed medication from your doctor as well as lifestyle changes.
