1. Use an Antiseptic Cleanse
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.
An antiseptic or antibacterial wash used in areas prone to HS can reduce draining and odor caused by bacteria. Fernandez 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.
Shawn Kwatra, MD, the chair of the department of dermatology at the University of Maryland School of Medicine in Baltimore, 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 loofahs, brushes, or washcloths are harmful for people with HS. It may be fine to use them gently, but steer clear of any 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, like clindamycin, for affected areas.
“We often recommend prescription clindamycin and clindamycin with benzoyl peroxide,” says Dr. Kwatra. According to research, clindamycin’s anti-inflammatory properties appear to be beneficial in the treatment of mild HS.
5. Remove Hair Between HS Breakouts
Keep hair follicles from getting clogged to help prevent HS lesions. Your dermatologist can recommend hair removal options, such as laser hair removal. Laser treatments reduce the number of hair follicles you have and decrease bacteria on your skin. Studies have shown it 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.
As for shaving and waxing, experts caution against ever waxing at all, because it can irritate the skin and make HS lesions worse. If you shave, first wash the area with an antibacterial soap, protect skin by using a gel-to-foam shaving gel, and shave carefully to avoid any nicks or cuts that could become infected and inflamed.
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 prevent sweating in other parts of your body. Tight clothes 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 decrease the amount of perspiration you produce.
7. Consider Diluted Bleach Baths
If other measures don’t control your HS well enough, talk to your dermatologist about 5- to 10-minute bleach baths, a tactic often recommended for atopic dermatitis, or eczema, to reduce the amount of bacteria on your skin.
This doesn’t mean submerging your body in full-strength bleach, though. Experts recommend adding a quarter- to half-cup of 5 percent bleach to a full tub of water (40 gallons) and soaking affected 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.
Don’t hesitate to ask your dermatologist if there are 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.”
The Takeaway
Life with hidradenitis suppurativa (HS) can be challenging because of the painful nodules and abscesses it causes.
Dermatologists recommend skin-care tips such as using antibacterial cleansers and avoiding thick creams to help manage flare-ups.
Remember to chat with your doctor about any new treatments or skin-care strategies you might consider to ease symptoms.
