Living with any chronic skin condition usually means making adjustments to your lifestyle. That’s because skin conditions often flare up in response to external, environmental factors—from the personal care products you choose to your current stress levels to what you’ve been eating. This definitely holds true if you’ve been diagnosed with hidradenitis suppurativa. Also known as acne inversa and often referred to as just “HS,” hidradenitis suppurativa is an inflammatory condition that involves painful, boil-like nodules or cysts that form under the skin, typically in warm crevices of the body—under the arms, in the groin or buttocks, under the breasts. Originating with infected hair follicles, these throbbing red lumps can sometimes burst, drain pus, and lead to scarring. Other symptoms of hidradenitis suppurativa include blackheads and, when the disease progresses and becomes more severe, larger abscesses and tunnels underneath the skin (known as fistulas or sinus tracts). Women are more likely to develop this condition, usually after puberty, and needless to say, it can be distressing to live with. While there isn’t yet a cure for hidradenitis suppurativa, there are medications that can help you manage the symptoms and greatly improve your quality of life, as well as day-to-day lifestyle habits that can also make a big difference. Here are some practical ways you can adjust your everyday routine to help minimize HS flare-ups and make living with a diagnosis of hidradenitis suppurativa easier.
Your bathing routine
While it’s not true that hidradenitis suppurativa is caused by poor hygiene, what you do in the shower can worsen flare-ups by irritating your skin—things like vigorous scrubbing, scented body washes, gritty exfoliators. Dermatologists recommend sticking to a gentle antiseptic wash that contains chlorhexidine or benzoyl peroxide, ingredients that fight the bacteria that contribute to HS cysts forming. Always look for sensitive-skin formulas—nothing abrasive, brightly colored, or heavily scented (fragrance-free is always the safest bet). If your skin feels itchy or dry, lathering up with a gentle, fragrance-free body wash is enough. Skip body scrubs or loofahs, which can cause irritation and exacerbate symptoms of hidradenitis suppurativa; gently rub with your hands instead. Taking a warm bath with Epsom salt is a skin-soothing option that many people with HS swear by when they’re in the midst of a flare-up, as is blow-drying affected areas instead of using a towel. It might sound crazy, but ask your dermatologist or other healthcare provider if you’d benefit from regular bleach baths as part of your treatment plan; adding a half cup of household bleach to your bath water can help decolonize bacteria that contribute to hidradenitis suppurativa. Proper wound care is also crucial each time you bathe; gently clean any open lesions with an antiseptic wash when bathing, then apply an over-the-counter antibiotic cream afterward, followed by a nonstick absorbent bandage.
Your undergarment choices
Many people with hidradenitis suppurativa experience nodules that appear in the areas of skin under their breasts. If this is an issue for you, it can be helpful to trade underwire bras for wireless, molded ones instead, to help reduce pressure and friction. If your genitals or groin area are affected, breathable cotton boy shorts can help cut down on friction as well as effectively absorb moisture (steamy conditions exacerbate symptoms of hidradenitis suppurativa). Another style you could consider trying: seamless underwear, which don’t have any elastic to rub against (and then irritate) the inner thigh and groin area. When practical, it can even be helpful to just go without underwear until a flare-up clears.
Your workouts
Exercise is extra-beneficial when you have a diagnosis of hidradenitis suppurativa, not only because it helps boost feelings of well-being and alleviates stress, but because it can help you maintain a healthy weight—obesity is one major risk factor that contributes to this skin condition. That said, there are a couple of factors to keep in mind when you work out. The first: friction. Hidradenitis suppurativa typically involves areas where skin rubs together, like your armpits and groin area, which can experience lots of friction when you’re working out. These areas also contain lots of sweat glands; when they’re in overdrive, hair follicles can become clogged, leading to cysts. One habit that can help you avoid making your symptoms of hidradenitis suppurativa worse when you work out: Choose loose-fitting, breathable gym clothes (although some people with HS like yoga pants as a way to reduce inner thigh friction; just be sure to change out of them promptly). Since heat aggravates this skin condition, try to work out when/where it’s cool, like early in the morning, in the evening, or in a basement or air-conditioned space. Post-workout, resist the temptation to hit the gym sauna, hot tub, or steam room. Instead, take a shower to clear away sweat and de-clog hair follicles. If you can’t shower right away, use gentle antibacterial wipes or sensitive-skin baby wipes to cleanse sweat from areas prone to flare ups.
Your personal care products
While we’re on the topic of sweat: Deodorant—especially strongly scented gel and solid formulas—can exacerbate hidradenitis suppurativa flare-ups. Some people with HS prefer using cream or spray deodorants, first covering any open lesions with a neutral protective balm like Aquaphor. If you prefer solid or gel deodorant, it can help to stick with sensitive formulas, which tend to avoid highly irritating ingredients like alcohol and baking soda and have mild or no fragrance. If you sweat heavily in your armpits, an antiperspirant that keeps you drier may help prevent the clogged hair follicles associated with this skin condition; your dermatologist or healthcare provider can help guide you toward one that’s gentle enough. Using a gentle antiseptic body wash when you bathe can also help control body odor without irritating your skin.
Your diet
If you have a diagnosis of hidradenitis suppurativa, improving what you eat really has the potential to really improve your quality of life. One of the biggest reasons: Eating right can help you maintain a healthy weight. Weight loss has been shown to dramatically improve symptoms of hidradenitis suppurativa in people who are overweight or obese—in one study, half of patients who lost 15 percent or more of their body weight saw their HS clear up entirely and 20 percent had fewer cysts. Beyond weight loss, a healthy diet has been shown to offer other benefits when it comes to this particular skin condition. According to the American Academy of Dermatology, a Mediterranean diet appears to be particularly beneficial for people living with HS—that means lots of seafood, fresh vegetables and fruits, whole grains, beans, and olives/extra virgin olive oil, only occasional red meat, and very minimal processed foods. The reason this diet is so impactful may be in part because of the anti-inflammatory omega-3 fatty acids in seafood, and because plant foods help cultivate a more diverse microbiome in our gut; people with HS have been shown to have a less-diverse gut microbiome. Dermatologists also recommend cutting back on sugar and refined carbs, which spike insulin levels, which can prompt HS flare-ups. Some people find that taking a zinc supplement can noticeably improve symptoms of this skin condition, due to its anti-inflammatory properties; ask your healthcare provider if this could work for you and what dose to try, as there are some side effects. Some people with HS find that their symptoms improve dramatically when they avoid brewer’s yeast (found in soy sauce, and some baked goods, alcohols and cheeses) or foods in the nightshade family, like tomatoes, peppers, and eggplant (picture any vegetable with a little “hat” made of leaves).
Skin Diseases | Hidradenitis Suppurativa:
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Your hair-removal techniques
First things first: waxing is a hair removal no-no when you have HS—way too likely to cause major inflammation. As for shaving, when you get to flare-up-prone areas like your armpits or groin area, take care to avoid nicks and cuts, which can easily become infected and turn into cysts; washing with antiseptic body wash can also help prevent this. It’s smart to avoid shaving affected skin when you have active hidradenitis suppurativa nodules or lesions. If letting hair grow for a while bothers you, try using an electric trimmer to give it a close trim; this won’t irritate like a razor blade can. Another idea worth considering, if you have the budget and time: Many people with early-stage (stage 1 or 2) HS benefit from laser hair removal as a way to greatly or completely reduce the need for future shaving, while also helping prevent the blocked hair follicles that contribute to lesions (since it works by zapping those hair follicles). In fact, studies have shown that laser hair removal may improve hidradenitis suppurativa symptoms in treated areas by more than 70 percent after three to four sessions. If you have a more severe case of HS, however, laser hair removal is generally not a good option, as it can’t effectively penetrate heavily scarred skin—and would be too painful.
Your laundry routine
As with personal-care products, fragrance-free is key when it comes to laundry detergent if you’re living with skin diseases. Hidradenitis suppurativa is certainly a condition that can be exacerbated by heavily scented detergents, which can prompt inflammation and irritation. If you frequently deal with underarm cysts that burst and drain pus and fluid, which can smell highly unpleasant and cause wet spots on your clothes, an easy hack is to stick a thin panty liner inside your shirt against the lesion; it’ll absorb the moisture and keep it from showing.
One of the best things you can do to make the day-to-day of hidradenitis suppurativa more manageable is to find a support group for people living with the same skin condition; the HS Foundation lists in-person support groups across the country, and there are also many online. There, you’ll find forums where people share more lifestyle tips—and which treatment options they’ve found success with. Beyond that, it can be comforting to know that others are working through the challenges of this skin condition one day and one choice at a time, just like you.
Skin Diseases | Hidradenitis Suppurativa:
