Navigating hidradenitis suppurativa triggers is tricky. Actually getting diagnosed with hidradenitis suppurativa, a painful, chronic condition that causes lumps to form under the skin when hair follicles become obstructed, usually results in feelings of relief and validation. I would know—I have the condition myself. However, I also know very well that people with hidradenitis suppurativa quickly learn that finding the right treatment can be complicated. What works for some doesn’t work for others. Lifestyle changes—including avoiding hidradenitis suppurativa triggers—is a helpful avenue for people with hidradenitis suppurativa to explore as they search for treatment.
Below, I spoke with Benjamin Kaffenberger, M.D., a dermatologist at the Ohio State University’s Wexner Medical Center, for some insight into what might make hidradenitis suppurativa worse.
SELF: I wanted to start off with some basics. How important is it for people with hidradenitis suppurativa to follow a skin-care routine?
Dr. Kaffenberger: There’s not strong data to say it has to be done by any means, but many dermatologists are going to say it’s important to follow. Most critical is having a soap that has an antibacterial component, something like chlorhexidine (such as Hibiclens) or something like a Dial antibacterial would be sufficient, especially in the folds of the skin where hidradenitis suppurativa is more likely to appear, where bacterial colonization can occur.
However, some patients with hidradenitis suppurativa may have eczema as well as other common skin diseases. And they may say, “Hey, I dry out if I if I put antibacterial soap on my legs in the in the wintertime.” It’s very reasonable to use a much gentler soap everywhere else on your body, except for the folds of the skin—armpits, backside, groin, under the breasts.
Should people with hidradenitis suppurativa avoid washcloths and loofahs? Do those things irritate the abscesses or boils?
It could. I think it depends on the stage of hidradenitis suppurativa and how severe it is. I think it definitely could be painful for some. But I don’t think it’s really critical for patients to avoid that as long as they didn’t have draining wounds. If there’s a lot of fluid coming out, then I wouldn’t want them using a loofah or washcloth just because it could spread bacteria. But if they are in an early stage, I think it’s reasonable to use them.
What are some things people with hidradenitis suppurativa should avoid when it comes to pain management? I know applying a warm compress to boils or abscesses can help reduce pain and/or bring a boil to a head, but are there things to avoid?
Applying a warm compress is probably one of the best things you can do. Patients shouldn’t take someone else’s pills or go above the recommended limits with pain medication.
In general, if someone wants to see an acupuncturist who focuses on chronic pain, I don’t have a concern with that as long as they are seeing someone reputable who is not aiming for hidradenitis suppurativa areas.
And someone with hidradenitis suppurativa should not try and pop or lance an abscess themselves, correct?
Probably not. I have patients that do it, and then the pain feels better, but there’s a risk of infection. And it can happen on its own to some degree as well, due to the pressure of sitting or applying a warm compress. In general, I would encourage patients not to do it themselves.
What are the risks of wearing tight clothing or using potentially irritating products like detergents or lotions?
You could get an allergic reaction or inflammation. Irritation around the hair follicles could contribute to clogging of the follicles, which would be the initial step of hidradenitis suppurativa. That’s why I would be cautious of the products someone is using.
In terms of tight clothing, the frictional component of rubbing on the skin is really the big concern. Clothing that does not increase the amount of friction on the skin is the most important thing.
As far as leggings go, what I tell patients is that while tight-fitting clothing is generally thought to be bad, I think it has to do with more with how it fits. If it’s not rubbing on your skin and if it’s protecting your thighs from rubbing together, I think that’s okay.
You will more likely run into trouble when you have clothing that fits poorly, and the clothing itself is causing additional rubbing. This is why there is a recommendation for loose-fitting clothing. But if you’re wearing something loose and your thighs are still rubbing together, that’s still friction on the skin.
Do you recommend someone with hidradenitis suppurativa shave or try laser hair removal?
Most of my patients shave. If they’re not getting razor burn or irritation, it’s fine to do. But if a patient notices their hidradenitis suppurativa symptoms are worsening, we need to alter their technique.
Laser hair removal has been shown to be helpful, if it can be done. The challenges are cost and if your insurance will cover it. If they can make it work, I encourage my patients to look into that, so you’re not dealing with shaving.
How does weight play a role in hidradenitis suppurativa?
We don’t totally know why, but there is an association between weight and hidradenitis suppurativa symptoms. One hypothesis is that individuals who are heavier are more predisposed to more skin-on-skin contact, which causes friction.
But there is another hypothesis that hidradenitis suppurativa puts patients at higher risk for metabolic issues, which lead to weight gain.
Are there any fitness activities that you think people with hidradenitis suppurativa should avoid?
Hidradenitis suppurativa patients have all different body shapes, so it’s hard to say what will or won’t help. I have heard from a number of patients that biking can be very challenging, because of the friction caused by the bike seat.
Getting in the pool is a great thing to do first. It’s a low-impact, low-friction activity that helps patients get active and get their heart rate up. That and walking are two activities I would first recommend.
Should those with hidradenitis suppurativa shower right after exercising?
Yes, I have patients do that right away to get the sweat off their skin—along with using antibacterial soap. For patients who are biking or doing a higher-impact activity, there are a number of anti-chafing products or body butters they can put on to reduce friction. But you want to make sure they are thin and won’t clog the hair follicles.
Smoking and tobacco use is especially not recommended for people with this condition, correct?
Yes, definitely. There’s an association involved. And there’s no reason not to help patients stop smoking, no matter what. If there is one lifestyle change to make to help with hidradenitis suppurativa, this is it.
Have you noticed that stress plays a role?
I think it plays a role in all skin and autoimmune diseases, and patients tend to flare during stressful times. There are different triggers for everyone, but this one is common. Sometimes it’s hard to address this, but I think there can be helpful tools.
This interview has been edited for length and clarity.
Related:
5 Surprising Skin Symptoms That Can Be Hidradenitis Suppurativa
10 Ways to Make Life With Hidradenitis Suppurativa Easier
My Chronic Skin Condition Made Me Quit the Gym