Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition characterized by painful, recurring lumps, abscesses, and tunnels under the skin. These lesions typically appear in areas where skin rubs together, such as the armpits, groin, and buttocks. A “flare-up” is when these symptoms intensify, leading to increased inflammation, pain, and overall symptom severity. While the exact cause of HS remains unclear, certain factors can trigger or worsen these flare-ups.
Common Environmental and Lifestyle Triggers
Friction from clothing or skin rubbing together can irritate affected areas, potentially leading to HS flare-ups. Tight-fitting clothes, especially synthetic materials, can increase friction and trap heat, exacerbating symptoms. Opting for loose, breathable fabrics like cotton can help reduce this irritation.
Heat and humidity can also contribute to flare activity, as excessive sweating may clog pores and promote inflammation. Managing indoor temperatures and keeping skin dry can be helpful.
Smoking is strongly associated with HS; tobacco smokers are more likely to develop the condition and experience more severe symptoms. Chemicals in tobacco smoke promote pro-inflammatory cytokines, contributing to inflammation in HS lesions. Quitting smoking can improve outcomes and treatment response.
Dietary factors are often cited as triggers for HS flare-ups, though responses are highly individual. Some report that dairy, sugar, nightshade vegetables (like tomatoes and potatoes), and brewer’s yeast can worsen symptoms. These foods may influence hormone levels or promote inflammation.
Stress is a frequently reported trigger for HS flare-ups, with many patients observing a link between stress levels and symptom exacerbation. Stress releases hormones like cortisol, which can increase inflammation. The chronic nature of HS can also contribute to elevated stress, creating a cycle.
Certain medications or personal care products might also act as triggers. For instance, some hormonal birth control options and lithium have been linked to worsening HS symptoms. Products with artificial fragrances or harsh ingredients can also cause skin irritation.
Internal Physiological Triggers
Hormonal fluctuations play a role in HS activity, with the condition often starting around puberty and changing during menstrual cycles, pregnancy, and menopause. Many women report worsening HS symptoms around their menstrual period, possibly due to decreasing estrogen and progesterone. The exact interplay of these hormones is still under investigation, but their influence is evident.
HS involves immune system dysregulation, where the body’s own response contributes to inflammation. The body mistakenly attacks hair follicles, leading to abscesses, chronic inflammation, and scarring. Therapies that modulate the immune system are sometimes used in severe cases.
Bacteria within hair follicles can contribute to inflammation. Blockage of hair follicles with keratin, sweat, and bacteria can lead to bursting, activating the immune system and resulting in abscess formation. These internal factors are often less directly controllable through lifestyle adjustments than environmental triggers.
Recognizing Your Personal Triggers
Identifying individual HS triggers involves careful observation and consistent tracking. Keeping a detailed flare-up diary or journal is a valuable tool. In this journal, individuals can note the timing and severity of flare-ups, along with potential preceding factors such as dietary intake, stress levels, specific activities, types of clothing worn, or menstrual cycle phase.
Patience and consistency are important when tracking, as patterns may emerge over weeks or months. This systematic approach helps individuals connect specific exposures or internal states to their symptom exacerbations. The goal is to identify unique sensitivities that might not be universal for everyone with HS.
Working closely with a healthcare professional, such as a dermatologist, is important to discuss potential triggers and develop a personalized management plan. A dermatologist can offer guidance on interpreting observations and integrating trigger avoidance strategies with medical treatments. This collaborative approach empowers individuals to better understand and mitigate their own flare-ups.