While the exact cause of HS isn’t known, certain things can increase your risk of a breakout or make breakouts worse. Here are common factors that can exacerbate HS.
1. Being overweight
Losing weight may be one of the most effective ways to manage HS, according to the American Academy of Dermatology (AAD). “There are plenty of thin people with the condition, but we do know being overweight is a risk factor,” says John Frew, MD, PhD, a clinical scholar in the Laboratory of Investigative Dermatology at The Rockefeller University in New York. Extra weight can also make HS symptoms worse because your skin rubs together more, which can increase friction and sweat between skinfolds. Sweaty areas then increase the acidity of the skin and promote certain bacteria to grow. What’s more, fat tissue produces inflammation hormones, which can worsen the underlying inflammation of HS.
2. Sweating
“Some people do report that heat and sweating make HS worse, but it is not clear whether it is due to the rubbing of skin together or more complex factors, such as bacteria and acid levels in the skin,” says Dr. Frew. Exercise is one potential cause of sweating. But even if it exacerbates your symptoms at first, exercise can be beneficial in the long run if it helps you lose weight, says Francisco Kerdel, MD, founder of the Florida Academic Dermatology Center. To reduce sweating while exercising, wear breathable cotton workout clothes and take frequent breaks. You should also stay hydrated and shower after you finish your workout. The AAD also suggests asking your dermatologist to recommend an antiperspirant, as some may be too harsh for people with HS.
3. Tight-fitting clothing
If you have HS, you have to think about more than style when choosing what to wear. Tight clothing rubs against your skin, which can lead to an HS flare, according to the AAD. Instead, opt for loose-fitting, breathable clothes to help reduce friction, chafing, and sweating.
4. Shaving affected areas
It’s difficult to shave if you have active HS, and it’s also not recommended, because it can irritate the affected skin. And if you develop an ingrown hair, you could become even more likely to develop a new HS lesion, says Dr. Kerdel. He recommends laser hair removal to affected areas to eliminate the hair follicles, which is where HS originates. Talk to your dermatologist about hair removal methods that work for you.
5. Smoking
This skin disease could be a good reason to finally kick a bad habit. “Smoking seems to be definitely associated with worsening disease and should be addressed in the beginning,” says Kerdel. A study published in January 2017 in the Journal of the American Academy of Dermatology shows that nonsmokers respond better to HS treatments than smokers do. If you need to quit smoking, talk to your doctor about resources that may help. Nicotine replacements, prescription medication, and expert help are among the best ways to quit smoking.
6. An unhealthy diet
While there’s no specific diet for HS, what you eat may play a role in how well you manage the condition. Eating a well-balanced, healthy diet rich in fruits and vegetables and low in soda and fast food is an important part of managing any medical condition, says Frew, “as we know that unhealthy eating and weight gain can worsen many medical conditions.” According to a review published in November 2019 in the International Journal of Dermatology, eliminating dairy, eating less sugar, and avoiding food made with brewer’s yeast may help some people with HS. “While there are many diets reported to give dramatic results in hidradenitis suppurativa, none are backed up by scientific evidence,” notes Frew. “Avoiding some foods helps some patients control their flares, but in my experience it is different foods for different people. There is no single diet that can cure HS.” A dietitian can help you develop a meal plan that works for you and helps you control your weight.
7. Stress
“Stress is a very common factor making hidradenitis suppurativa worse,” says Frew. “And the stress can come from anxiety surrounding the unexpected nature of flares, causing a chronic cycle of stress and worry.” He recommends talking to your doctor about medical and nonmedical therapies that can help manage the stress that comes with living with a chronic condition such as HS. This may include meditating, practicing relaxation techniques, or working with a mental health professional.
8. Skin irritation or injury
HS can be aggravated by cuts from shaving or even irritation from wearing a helmet or headband, according to a review published in January 2016 in the journal Dermatologic Clinics. The culprit could be the combination of friction and a warm, moist environment. Avoiding unnecessary trauma or irritation to your skin — including squeezing or popping the lumps or sores — is an important part of managing HS, suggests a review published in December 2018 in the journal Rheumatology.
