At SkinSAFE, we’ve been getting more and more requests about Hidradenitis Suppurativa over the last few months. Maybe it’s due to an older episode of Dr. Pimple Popper, maybe it’s from the newer show "Bad Hair Day" with Dr. Meena Singh
So let’s set the tone…What is Hidradenitis Suppurativa?
(HS) is a chronic, inflammatory skin condition that manifests in the formation of small, painful lumps under the skin. The lumps usually develop in areas where the skin rubs together, such as the armpits, groin, buttocks, and under the breasts. These are also areas where apocrine sweat glands can be found. Apocrine sweat glands drain into hair follicles. When these follicles become inflamed, the lumps develop.
The painful, often itchy lumps, discharge, and accompanying malodor can be debilitating. The lumps heal slowly, often recur, and may lead to fissures or sinuses developing under the skin.
Globally, HS is thought to affect approximately 1% of the population, though some estimates go as high as 4%. The disparity may be due to lack of public knowledge about the condition and hesitancy of those with it to seek treatment. Those afflicted are often embarrassed by their symptoms, leading to a delay in seeking care. Regardless, given the population of the USA alone, that’s between 3 and 13 million people. That’s a LOT.
Can Hidradenitis Suppurativa be cured?
HS cannot presently be cured, but symptoms can be managed with medical treatment following diagnosis by a healthcare provider familiar with the condition.1,2 Treatment can include medications, surgery, and lifestyle modifications. In terms of skin care, some dermatologist recommendations include antimicrobial washes and antiseptic washes containing benzoyl peroxide or zinc pyrithione washes.3-5
Hidradenitis and Comorbidities
HS is often accompanied by other health conditions. These are referred to as comorbidities, and can include, but are not limited to, psoriasis, acne, cellulitis, and sepsis.
Rose, one of our SkinSAFE® Trusted Friends™, was recently diagnosed with HS. She explained that she had developed painful lumps under her arms and in the bikini area. Initially she thought it was irritation from shaving, but they became progressively worse, and there was an embarrassing odor which she was very self-conscious of. She tried a huge number of products she found online over the year with no success. When she was finally able to see her dermatologist, she was diagnosed with HS.
In addition to systemic treatment, Rose’s doctor suggested a few changes to her daily routine. She was advised to avoid using thick, heavy moisturizers, which can clog hair follicles. Over-the-counter antimicrobial washes were suggested at least once a week to start.6 However, the biggest change was to her daily showering habits. “I love taking long, hot showers, and scrubbing with a loofa, but she said doing that can irritate the skin and provide a warm, moist environment that allows bacteria to grow, contributing to inflammation. “Now I take brief showers, wash gently with a washcloth, and dry off thoroughly before getting dressed.” Her dermatologist also suggested seeking out a fragrance-free, hypoallergenic antiperspirant to help with sweating, though I have not been able to find any aluminum free antiperspirants. I see so much about going aluminum-free on the social media and trying to find a product is hard.”
David Mays, PharmD, says there is a simple explanation for that, “Finding aluminum-free antiperspirants can be a huge challenge given the limited number of ingredients that are recognized for their ability to decrease sweating.“ This is because an antiperspirant is considered an over-the-counter drug by the United States Food and Drug Administration, and of the 18 ingredients recognized currently, 100% start with the name aluminum,” said Dr. Mays. A lot of companies in this space have been marketing “aluminum-free deodorants,” and since these products are found intermixed on the store shelf with true antiperspirants, shopping can be very confusing. I feel strongly that many people have purchased products based on aluminum-free claims only to find out that while they didn’t smell, they still soaked their undershirts and clothes. Look for antiperspirants without fragrance and those that are rated SkinSAFE 100 if you have sensitive skin needs,” said Dr. Mays.
In addition, just because a product is labeled 'hypoallergenic' or for ‘sensitive skin’ does not mean it does not contain allergens or irritants. The use of these terms is not federally regulated. The SkinSAFE® standard for sensitive skin can guide consumers like Rose to products, including antiperspirants and antimicrobial washes that exclude the topmost common allergens and irritants. This could possibly help those with HA avoid instances of inflammation which may be caused by the inadvertent application of allergens or irritants found in some personal care products.
Here are a few Trusted FriendsTM favorite antiperspirants and antimicrobial washes.
- Frew JW, Hawkes JE, Krueger JG. Topical, systemic and biologic therapies in hidradenitis suppurativa: pathogenic insights by examining therapeutic mechanisms. Ther Adv Chronic Dis. 2019 Mar1;10:2040622319830646. doi: 10.1177/2040622319830646. PMID: 30854183; PMCID: PMC6399757
- Magalhães, R. F., Rivitti-Machado, M. C., Duarte, G. V., Souto, R., Nunes, D. H., Chaves, M., Hirata, S.H., & Ramos, A. (2019). Consensus on the treatment of hidradenitis suppurativa - Brazilian Society of Dermatology. Anais brasileiros de dermatologia, 94(2 Suppl 1), 7–19. https://doi.org/10.1590/abd180...
- Ghanian, S., Yamanaka-Takaichi, M., Naik, H. B., & Alavi, A. (2022). Medical Management of Hidradenitis Suppurativa with Non-Biologic Therapy: What's New?. American journal of clinical dermatology, 23(2), 167–176. https://doi.org/10.1590/abd180...
- Danesh MJ, Kimball AB. Pyrithione zinc as a general management strategy for hidradenitis suppurativa. J Am Acad Dermatol. 2015;73(5):e175. doi:10.1016/j.jaad.2015.07.026
- Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619-644. doi:10.1111/jdv.12966
- Leiphart P, Kitts S, Sciacca KJ. Adherence to Over-the-Counter Antimicrobial Washes in Hidradenitis Suppurativa Patients. Dermatology 2019;235:440–441. Available online at: https://www.karger.com/Article/FullText/500827.