Hidradenitis Suppurativa (HS) is a chronic, inflammatory skin condition that creates painful, deep lumps and abscesses beneath the skin. It typically affects areas where skin rubs against skin, such as the armpits, groin, inner thighs, and under the breasts. While HS requires professional medical management, self-care strategies can safely manage symptoms and improve quality of life. This guidance focuses on supportive measures to manage flares and maintain skin health.
Daily Skin and Lesion Care
Maintaining meticulous yet gentle hygiene is fundamental to managing Hidradenitis Suppurativa. Daily cleansing should focus on reducing the bacterial load without causing irritation. Dermatologists often recommend using mild, non-irritating soaps or antiseptic washes containing ingredients like 4% chlorhexidine, benzoyl peroxide, or zinc pyrithione to control surface bacteria.
When washing, apply cleansers with clean hands and avoid harsh scrubbing, which can increase inflammation and worsen lesions. After cleansing, gently pat the affected areas completely dry, as moisture can exacerbate the condition. Proper wound dressing is also an important part of daily care for active lesions. Non-adhesive or silicone-based dressings are preferred to prevent trauma upon removal.
For lesions with light drainage, hydrocolloid dressings reduce friction and support a moist wound-healing environment. For heavier drainage, highly absorbent foam or super-absorbent dressings may be necessary to manage exudate. Change dressings regularly to maintain cleanliness and prevent infection, ensuring the area is dry before applying a new one. Avoid picking at or attempting to drain lesions, as this can lead to further inflammation and infection.
Managing Acute Pain and Inflammation
When a painful flare-up occurs, immediate measures can provide significant relief. Warm compresses are a widely recommended home treatment, helping to reduce swelling, ease pain, and encourage superficial lesions to drain naturally. Apply a clean washcloth soaked in warm (not hot) water, or a steeped black tea bag, to the painful area for 10 to 15 minutes, repeating several times daily as needed.
Alternatively, cold compresses, such as a wrapped ice pack, can be used for immediate localized pain and swelling reduction, especially for nodules that are not draining. Some individuals find relief by alternating between warm and cold compresses. For lesions located in the groin or buttock area, a warm sitz bath can be soothing, decreasing pain and swelling. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can temporarily reduce both the pain and inflammation associated with a flare, provided dosage instructions are strictly followed.
Lifestyle Adjustments to Reduce Flares
Long-term management of HS involves addressing systemic and environmental factors that can trigger or worsen symptoms. Smoking cessation is one of the most significant lifestyle changes that can improve HS severity, as smoking is strongly associated with more extensive disease and can make medical treatments less effective.
Weight management is another important factor, particularly for individuals who are overweight or obese. Excess weight increases skin-on-skin friction and systemic inflammation. Studies have shown that weight loss can lead to an improvement in disease severity, especially when initiated in the early stages of HS. Minimizing friction on the skin is also beneficial, achieved by wearing loose-fitting clothing made from breathable, natural fabrics like cotton. Avoiding tight waistbands or restrictive undergarments helps prevent mechanical irritation that can trigger a flare.
Dietary modifications may also play a role, although triggers can vary greatly among individuals. Some people with HS report that avoiding certain foods, such as dairy products and high-glycemic index items, can lead to a reduction in flare frequency and severity. Focusing on a healthy, balanced eating pattern and identifying personal food triggers can be a valuable self-management technique.
Knowing When to Seek Professional Care
While home care methods are essential for supportive management, they are not a substitute for professional medical treatment. See a dermatologist or healthcare provider if your symptoms are painful, difficult to manage, or impede your movement.
You should seek immediate medical attention if you notice signs of a systemic infection. These warning signs include a high fever, rapid spread of redness or streaking away from the lesion, chills, or a foul-smelling discharge. Any lesion that is rapidly worsening, does not improve within a few weeks of home care, or if new lumps appear frequently, requires a medical evaluation. Professional guidance is necessary for diagnosis, prescription treatments, and managing complications like deep tunnels forming beneath the skin.