Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition affecting the hair follicles and associated sweat glands, primarily in areas where skin rubs together, such as the armpits, groin, and under the breasts. HS is characterized by recurring, painful nodules, abscesses, and the formation of tunnels beneath the skin. While HS is an immune-mediated disease, a targeted and consistent cleansing routine is a significant component of managing symptoms and preventing complications. This routine focuses on controlling the skin’s surface environment to minimize the frequency and severity of flare-ups.
The Role of Cleansing in HS Management
Targeted daily cleansing supports HS management by addressing the bacterial load on the skin’s surface, which can contribute to secondary infection and inflammation within the hair follicles. Although HS is not primarily a bacterial infection, the presence of skin bacteria in affected areas can exacerbate the immune response and worsen existing lesions. Using specific cleansers helps to reduce the population of these microbes without causing excessive irritation to sensitive skin.
Gentle washing removes sweat, debris, and dead skin cells that could otherwise clog the hair follicles, supporting the skin barrier function. Consistent hygiene is a supportive measure, working alongside prescribed medical treatments to reduce the symptoms and improve the overall skin environment for individuals with HS.
Recommended Cleanser Types and Key Ingredients
The most effective cleansers for HS generally contain active ingredients with antimicrobial or keratolytic properties, which act on the skin to reduce bacteria and unclog pores. These medicated washes are typically used on the areas affected by HS, while the rest of the body may benefit from a gentler, non-medicated wash. The selection of the active ingredient often depends on the severity of the condition and the individual’s skin tolerance.
Chlorhexidine Gluconate (CHG)
Antiseptic washes are a primary recommendation, with Chlorhexidine Gluconate (CHG) being a widely supported option, often used in a 4% concentration. CHG is a broad-spectrum biocide that works by disrupting the cell membranes of various bacteria, significantly reducing the surface bacterial load on the skin in a short contact time. This reduction in microbial presence can lessen the likelihood of secondary infections that fuel inflammation in HS lesions.
Benzoyl Peroxide
Benzoyl Peroxide functions as both an antiseptic and a mild keratolytic agent. It releases oxygen into the follicle, creating an environment toxic to certain bacteria. It also helps to gently exfoliate the lining of the hair follicle to prevent clogging. Benzoyl peroxide is particularly valuable because it does not promote antibiotic resistance and can be used in strengths ranging from 2.5% to 10% in wash formulations.
Gentle Cleansers
For daily use, especially on non-flaring skin or for individuals who cannot tolerate stronger active ingredients, a gentle, pH-neutral, non-soap cleanser is recommended. These cleansers are formulated to remove impurities without stripping the skin’s natural moisture barrier, which is important for maintaining skin integrity. Other ingredients like zinc pyrithione may also be suggested due to their bacteriostatic and fungistatic properties, although they are primarily supported by professional opinion rather than extensive clinical studies for HS.
Cleansing Agents and Practices to Avoid
To prevent triggering flares, individuals with HS should avoid using products and practices that cause physical or chemical irritation to the skin. Physical irritants should not be used on affected areas. The friction caused by these items can easily exacerbate inflammation and lead to the formation of new lesions.
Physical irritants include:
- Abrasive scrubs
- Rough washcloths
- Loofahs
- Sponges
Certain chemical ingredients should also be avoided because they can strip the skin barrier, increasing sensitivity and inflammation. Known contact irritants include heavy fragrances, dyes, and alcohol. Additionally, sulfates, such as Sodium Lauryl Sulfate (SLS) or Sodium Laureth Sulfate (SLES), can be overly harsh and excessively dry out the skin. It is advised to avoid heavy moisturizing bar soaps or products that leave a high residue. These residues can contribute to the clogging of hair follicles. Choosing non-comedogenic liquid cleansers helps ensure the product will not block pores and will rinse cleanly.
Application Techniques and Post-Cleansing Care
The way cleansers are applied is as important as the product selection, as technique directly influences the risk of irritation. Water used for bathing should be lukewarm, as hot water can increase inflammation and dry out the skin, compromising the skin barrier. Cleansers should be applied using the fingertips or a clean, soft hand, without any scrubbing or vigorous rubbing motions, especially over active lesions or painful areas.
For antiseptic washes like Chlorhexidine Gluconate, allow the product to remain on the skin for approximately one to two minutes before rinsing. This residency time allows the active ingredient to effectively reduce the surface bacterial population. After the necessary contact time, a thorough rinse with lukewarm water is necessary to ensure no product residue remains, which could otherwise cause drying or irritation.
The final step in the routine is drying the skin, which must be performed gently by patting the area with a clean, soft towel, rather than rubbing. This patting motion avoids the friction that can irritate hair follicles and trigger a flare. If a topical treatment or a non-comedogenic moisturizer has been prescribed by a healthcare provider, it should be applied immediately after the skin is dried to lock in moisture and deliver the medication.