Dermatologist-Approved Skin-Care Tips for Hidradenitis Suppurativa

If you have hidradenitis suppurativa (HS), you’re familiar with the painful nodules, bumps, and abscesses that develop in places where your skin rubs together, such as your armpits and groin. This chronic inflammatory disease causes lesions that may break open and drain fluid underneath the skin. They tend to heal with scarring and may eventually form tunnels under the skin that chronically drain fluid.

“It can be an extremely painful condition,” says Anthony Fernandez, MD, PhD, a dermatologist at Cleveland Clinic in Ohio. Because the inflammation of HS often affects other organs, it’s considered a systemic disease and has been linked to an increased risk for other chronic conditions, including cardiovascular disease and inflammatory arthritis.

It’s important to talk to your doctor if you think you have HS. Prescription medications, such as corticosteroids and biologics, help reduce inflammation and prevent future 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, a dermatologist and assistant professor of dermatology at the Johns Hopkins University School of Medicine in Baltimore. Your doctor may also recommend surgical treatments, 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). It can also help reduce your risk of health problems such as heart disease and diabetes. If you’re a smoker, quitting also helps reduce the frequency and severity of HS flare-ups.

Another important way you can help manage HS is to follow a daily skin-care routine. Here are eight dermatologist-approved skin-care tips to help keep your HS in check.

1. Use an antiseptic cleanser

A variety of bacteria live throughout your body, including in your hair follicles. If you have HS, hair follicles get clogged and burst, releasing bacteria into underlying skin, which activates the immune system, says Dr. Fernandez.

Using an antiseptic or antimicrobial wash can help limit flares by minimizing bacteria overgrowth in areas prone to HS, which helps when hair follicles do rupture. “There’s less bacteria that 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 concoction surgeons use at hospitals.

Start by using an antiseptic cleanser all over once a week. If it works well without irritating your skin, you can use it up to once per day.

2. Try over-the-counter acne medications

Acne washes with benzoyl peroxide are another helpful tactic for inflammatory skin conditions, such as HS. Like antiseptic washes, they decrease the total bacteria count on the skin’s surface.

3. Avoid scrubbing your skin

There’s no clear consensus on whether using loofahs, brushes, or washcloths is harmful for people with HS. It may be fine to use them gently, but avoid scrubbing affected areas, which does more harm than good by causing trauma to already inflamed skin.

“Hidradenitis suppurativa is not caused by poor hygiene,” says Fernandez. “[Scrubbing] is one of the worst things to do, because we think trauma can precipitate flares.”

4. Skip thick creams and ointments

Opt for antimicrobial washes and light moisturizers over thicker OTC creams or ointments. “The cream base itself can get in hair follicles and continue to plug them, which can aggravate HS over time,” says Fernandez.

Instead, talk to your doctor about prescribing a topical antibiotic for affected areas. “We often recommend prescription clindamycin and clindamycin with benzoyl peroxide topical preparations,” says Kwatra. Also ask your dermatologist which moisturizer may be best for you.

5. Shave or wax between HS breakouts

If you’re in the middle of a flare, the AAD says to avoid shaving, which can cause trauma and inflammation to the area, making HS lesions worse. Your dermatologist can recommend alternative methods of hair removal.

6. Keep skin sweat free, especially in areas prone to HS

Moist, warm environments encourage bacteria overgrowth, which can potentially clog hair follicles. Using an antiperspirant can help. Some people are allergic to fragrances in deodorants, so look for an unscented, hypoallergenic option. You can also try applying baby powder to areas prone to sweating.

Wearing loose-fitting clothing is another smart tactic to stay cool. Tight- fitting clothes may aggravate HS when they rub against areas prone to inflammation and lesions, clogging hair follicles and causing trauma to the skin, says Fernandez.

If sweating remains a problem for you, talk to your doctor. Prescription antiperspirants, oral medications, and even Botox can help decrease the amount of sweat you produce. “We have lots of strategies,” says Fernandez.

7. Talk to your doctor about bleach baths

If these other tactics aren’t controlling your HS, talk to your dermatologist about taking 5- to 10-minute bleach baths. They’re usually recommended for atopic dermatitis or eczema to help decrease the overall bacteria on skin.

While the idea of sitting in bleach might sound toxic, you’ll use less than a quarter cup of bleach in a full tub of bathwater. Just be sure to get specific instructions from your dermatologist first, since using too much bleach can break down the skin barrier and cause far more problems, says Fernandez.

Remember that it’s always a good idea to keep in close touch with your doctor or dermatologist, especially if you’re in the middle of an HS flare. “Try not to take things into your own hands,” says Fernandez. Be sure to ask if there any new medicines or skin-care tactics that can help reduce HS lesions. “Our understanding of HS is evolving rapidly. This is a disease that’s been ignored for decades,” he says, but much more research is now being conducted.

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