Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that affects about 1% of the population. It causes painful lumps under the skin, typically in areas where skin touches skin, such as:5
- Armpits
- Groin
- Buttocks
- Under the breasts
These lumps can break open, causing abscesses, scarring, and tunnels under the skin called sinus tracts.5
HS develops from a combination of genetics, hormones, and lifestyle factors. It begins with a problem in the hair follicles that leads to blockages, inflammation, and painful flare-ups.5
Living with HS can be challenging, affecting both physical comfort and emotional well-being. While there’s no cure yet, identifying and avoiding these triggers can help manage symptoms and improve quality of life.5
1. Friction and Skin Irritation
Your clothing choices may be making your HS symptoms worse without you realizing it.4
How it affects HS: Friction from tight-fitting clothes can irritate areas where HS typically develops, potentially triggering or worsening flare-ups.4
What you can do:
- Choose loose, breathable fabrics, especially during flare-ups
- Avoid underwire bras
- Skip underwear with tight elastic bands
- Opt for cotton and other natural fibers when possible
2. Dietary Triggers
What you eat can significantly impact your HS symptoms by either reducing or increasing inflammation in your body.3
Foods that may worsen HS:
- Dairy products (contains casein and whey that can increase hormones related to HS)
- High-glycemic foods (junk food, cakes, cookies, potato chips)
- Refined carbohydrates
- Processed foods
- Sugary items
Better choices: A Mediterranean-style diet may help reduce HS symptoms because of its anti-inflammatory properties. This includes3:
- Extra-virgin olive oil
- Vegetables and fruits
- Whole grains
- Legumes and nuts
- Moderate amounts of fish
- Limited amounts of eggs and sweets
The anti-inflammatory benefits come from fiber, polyphenols, carotenoids, and omega-3 fatty acids found in these foods.3
3. Smoking
For those living with HS who also smoke, understanding the connection between smoking and symptom flare-ups can be an important step toward better skin health. The relationship between smoking and HS is significant and well-documented in research.2
How smoking worsens HS:
- Nicotine and chemicals in cigarettes trigger inflammation
- Promotes production of inflammatory proteins (TNF-α, IL-1α, IL-1β, and IL-8)
- Changes skin’s microbiome
- Inhibits natural antimicrobial protection
- Makes HS more resistant to treatment
Research shows that people who quit smoking have a lower risk of HS compared to those who continue smoking. The reduction in HS risk becomes more pronounced the longer someone remains smoke-free.2
4. Chronic Stress
The mind-body connection is particularly strong with skin conditions like HS.
How stress affects HS7:
- Triggers release of cortisol and other stress hormones
- Increases inflammation throughout the body
- Creates a vicious cycle: stress worsens HS, and HS symptoms increase stress
Stress management strategies4:
- Deep breathing exercises
- Meditation
- Progressive muscle relaxation
- Regular physical activity
- Adequate sleep
- Support groups or therapy
Many of these techniques only take a few minutes and can be done almost anywhere when you feel tension building.
5. Poor Sleep Habits
Quality sleep is crucial for managing HS, yet pain and discomfort can make sleeping difficult.1
How poor sleep affects HS1:
- Disrupts hormone release patterns
- Increases inflammatory markers
- Weakens skin barrier function
- Reduces pain tolerance
Better sleep strategies1:
- Maintain consistent bedtime and wake-up times, even on weekends
- Create a relaxing bedtime routine
- Keep your bedroom cool (around 65°F) to help reduce inflammation
- Dim lights as bedtime approaches
- Use blue light blocking glasses in the evening if using electronic devices
- Exercise regularly, but not within 2-3 hours of bedtime
- Take any pain medication early enough to start working by bedtime
Taking Control of Your HS
While living with HS presents challenges, understanding your personal triggers can help you take back some control. Consider keeping a symptom journal to identify connections between flare-ups and potential triggers.
Remember that everyone’s HS is different. What triggers symptoms in one person may not affect another. Work with your healthcare provider to develop a personalized management plan that addresses your specific needs.
By making targeted lifestyle changes and avoiding these common triggers, you can potentially reduce flare-ups and improve your quality of life with HS.
References
- Afzal, U. M., & Ali, F. R. (2023). Sleep deprivation and the skin. Clinical and Experimental Dermatology.
- Ewumi, O. (2024, September 3). Hidradenitis Suppurativa Risk Reduces Over Smoke-Free Years. Retrieved from MedCentral: https://www.medcentral.com/dermatology/hidradenitis-suppurativa-risk-reduces-over-smoke-free-years
- Kesik, F., Dogan-Gunaydin, S., & Fisunoglu, M. (2024). The Impact of Diet on Hidradenitis Suppurativa Severity: A Cross-Sectional Case–Control Study. Medicina – An Open Access Journal from MDPI.
- Murphy, S. (2020, May 11). 6 Things That Can Make Hidradenitis Suppurativa Worse and How to Avoid Them. Retrieved from Healthline: https://www.healthline.com/health/hidradenitis-suppurativa/HS-make-worse
- Van Straale, K. R., Prens, E. P., & Gudjonsson, J. E. (2022). Insights into hidradenitis suppurativa. The Journal of Allergy and Clinical Immunology.
- Winfrey, S. (2022, September). Sleep and Hidradenitis Suppurativa: 6 Ways To Manage Nighttime Pain and Get Better Rest. Retrieved from My HS Team.
- Zhang, H., Wang, M., Zhao, X., Wang, Y., Chen, X., & Su, J. (2024). Role of stress in skin diseases: A neuroendocrine-immune interaction view. Elsevier – Brain, Behavior, and Immunity.
You Might Also Like:
Don’t Ignore These 5 Skin Changes
Ignoring certain skin changes can mean missing important signals your body is sending. Let’s talk about five skin changes you shouldn’t brush off, and what they might be telling you.
Advice on Having Sex with Hidradenitis Suppurativa (HS)
While the physical symptoms of hidradenitis suppurativa, or HS, can be challenging in themselves, the condition can also significantly impact a person’s intimate relationships. Tap to explore practical tips and more.
