Many people who have hidradenitis suppurativa (HS) struggle with how it affects their self-image. They feel the swollen bumps or boils that appear on their bodies can be off-putting to others who may not understand what HS is and how it works. They also worry the fluid that sometimes leaks from their lesions can smell bad. As a result, they may hold other people, even friends and loved ones, at arm’s length. That can lead to isolation and withdrawal–and in some cases, even depression.
While there’s no treatment that can magically clear up your hidradenitis suppurativa, you can take some steps to help you manage problems like body odor, so you don’t have to push people away.
1. Keep yourself clean.
HS tends to occur in areas containing the apocrine sweat glands. These are the sweat glands clustered around hair follicles, known for producing the smelly kind of sweat. Puberty kick starts these apocrine sweat glands, and sex hormones spur them into producing a protein-rich sweat that’s odorless until it’s exposed to bacteria. So, you have a double whammy from the same part of the body: the smell associated with those sweat glands coupled with the smell associated with the pus that leaks out of HS lesions or boils.
The key here is to follow a daily skin care routine. Wash your body regularly, but do so with care. Skip the harsh, scented soaps and opt for a gentle, soap-free body wash that won’t irritate your skin. You might also carry gentle cleansing wipes with you for quick touch-ups on sweaty or smelly areas when you’re away from home.
Some people have found that washing with an antimicrobial wash, like one that contains chlorhexidine, can help, too. It gets rid of any odor-causing bacteria. But it’s a good idea to test it out by using it just once a week to see how your skin reacts. If you get good results, you might be able to wash with it as often as once a day. You can also gently dab the antiseptic cleaner on any lesions that burst or rupture to wipe away the bad-smelling pus.
2. Use deodorant carefully.
Even people who don’t have any lesions in their armpits may still worry about body odor. For them, it may be just a matter of finding an effective deodorant or deodorant/anti-perspirant combo. But if you do have lesions in your armpits–or have had them in the past–you may need to be a little more careful. Friction can irritate HS lesions, and the armpit can definitely be a high-friction area. Talk to your dermatologist about the best type of deodorant to use that will be gentle on your skin but keep odor at bay.
3. Make wardrobe choices with care.
As you know, friction can be an issue for people with HS. You might like the look of a tight shirt or a snug pair of pants but stop and think for a minute about the fit and the fabric. Will the fabric rub up against any lesions you might have? Will it cause you to sweat more in those areas?
The last thing you want to do is don clothing that will create even more friction and perspiration and compound the problem. Tight fabric can rub against your irritated skin, causing pain and possibly speeding up the rupture of those lesions, causing that smelly pus to seep out. And you may find yourself sweating more when you’re wearing material that doesn’t breathe very well. That can produce more odor.
Keep these strategies in mind when picking out clothes:
- Opt for looser, more flowing attire as a general rule
- Forego clothes with tight waistbands or other features that might irritate lesions
- Look for natural fabrics that breathe and absorb perspiration, which can reduce odor
- Choose looser-fitting underwear, like boxer shorts or “boy shorts”
- Avoid bras with metal wires and thin straps, which can put pressure on lesions
- Consider using breast pads or bra liners to absorb sweat and drainage from lesions
You do need to wash your clothes regularly to remove bacteria, sweat, and stains. When you wash your clothes, choose a gentle detergent to avoid any additional irritation. An enzyme-free deterrent may be less harsh on your skin, as are detergents that are scent- and dye-free.
You may also need to consider a few other relevant issues, like hair removal. If you normally shave your underarms or wax your bikini line, you may want to consider how that affects any lesions you may have in that area. You may have to stop shaving those affected areas, so you don’t break open any lesions in those spots. Some people have had good results with laser hair removal instead–both as a treatment for their condition and for eradicating body hair in that area.
It’s important, too, to find the right treatment for your HS, so your cysts are as controlled as possible. Talk to your doctor about different treatment options, and don’t give up if the first few don’t work. With commitment and persistence, you can find something that works for you.
