Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition that causes painful, recurrent lesions, typically in areas where skin rubs together, such as the armpits, groin, and under the breasts. HS begins with the blockage and rupture of hair follicles, leading to inflammation and the formation of nodules, abscesses, and tunnels beneath the skin. While HS is not caused by poor hygiene, proper daily cleansing is a foundational element in managing the condition and reducing flare-ups. Selecting the right product involves focusing on ingredients that reduce bacterial load and minimize irritation to the already sensitive skin, as there is no single “best soap” for everyone with HS.
Why Cleansing is Crucial for HS Management
The underlying mechanism of HS involves follicular occlusion and a subsequent immune response. The resulting lesions are often aggravated by the bacteria that naturally live on the skin. The painful nodules and abscesses can lead to the formation of tunnels, contributing to chronic inflammation and malodor. Daily cleansing with specialized products is necessary to reduce this microbial population, often called the “bacterial burden.” Unlike common alkaline soaps, which can strip the skin’s protective barrier, a gentle cleanser helps maintain skin health and reduces the risk of secondary infections. Minimizing friction and irritation during washing is equally important, as mechanical trauma can trigger new inflammatory flares.
Key Active Ingredients Recommended for HS
Dermatologists recommend antiseptic or antibacterial washes to help control the bacteria that contribute to HS flare-ups. These products contain specific chemical agents designed to reduce the microbial population on the skin surface.
Chlorhexidine Gluconate (CHG)
Chlorhexidine Gluconate (CHG) is an antiseptic and disinfectant used in affected areas. Typically used in a 4% concentration, CHG works by disrupting the bacterial cell membrane to lower the bacterial count on the skin. For mild to moderate HS, applying the 4% wash once daily during showering and leaving it on for one to two minutes before rinsing is beneficial.
Benzoyl Peroxide (BP)
Benzoyl Peroxide (BP) functions as both an antiseptic and a mild exfoliant. BP is a bactericidal agent that releases oxygen into the pore, killing bacteria that thrive in the hair follicles. Washes are preferred over gels for HS, and concentrations ranging from 2.5% to 10% are available, though a 5% wash is common.
Zinc Pyrithione
Zinc Pyrithione is a topical agent known for its antimicrobial and anti-inflammatory properties. This ingredient is commonly found in over-the-counter medicated cleansers, often at a 2% strength. Zinc Pyrithione works by inhibiting the growth of both bacteria and fungi. Because these active ingredients can cause irritation, it is advisable to start with a lower frequency and perform a patch test before regular use.
Product Formats and Safe Application Techniques
The physical form of the cleanser and the technique used for application are important factors in managing HS. Liquid or foaming washes are preferred over traditional bar soaps because bars can harbor bacteria if not stored in a dry environment. However, medicated bar soaps containing active ingredients like Benzoyl Peroxide or Zinc Pyrithione can be gentle and effective for HS skin.
When washing, use only clean hands or a very soft, dedicated cloth, avoiding abrasive tools like loofahs, sponges, or brushes. The water should be lukewarm. Gentle application is key; cleansers should be massaged lightly onto the skin without harsh scrubbing, which can damage the skin barrier and worsen flares. After rinsing thoroughly, the affected areas must be gently patted completely dry with a clean, soft towel to prevent friction and moisture retention in skin folds.
Ingredients and Habits to Strictly Avoid
Specific ingredients and washing habits can exacerbate HS symptoms. Fragrances and dyes are irritants that should be avoided in all cleansers and topical products. Avoid products containing high concentrations of alcohol, as they dry out and strip the skin’s natural moisture.
Physical exfoliants, such as harsh scrubs or cleansers with abrasive particles, must be eliminated from the routine. Scrubbing causes unnecessary friction and trauma, which directly contributes to the development of new lesions. Practices to avoid include using scalding hot water or leaving skin damp after bathing, which promotes microbial overgrowth. Other ingredients to avoid are baking soda, parabens, and beta hydroxy acids.