Hidradenitis Suppurativa Skincare: What to Use on Affected Skin

Skincare for HS: Why It Requires a Different Approach

Hidradenitis suppurativa (HS) affects the skin in areas that standard skincare advice rarely covers — armpits, groin, inner thighs, buttocks, and under the breasts. The lesions are deep in the dermis (not on the surface), driven by follicular occlusion and immune dysregulation, not by dirty skin or bacteria alone. This means the goal of an HS skincare routine is different from a conventional one:

• Reduce surface bacterial burden without stripping the skin barrier
• Minimize follicular trauma — any friction, mechanical abrasion, or harsh chemistry makes flares worse
• Manage active lesions and wounds with appropriate dressings
• Support the surrounding skin's integrity so it can tolerate medical treatments

Skincare cannot treat HS — that requires medical and sometimes surgical intervention. But the right skincare routine meaningfully reduces flare frequency, manages discomfort between treatment episodes, and protects the surrounding skin from secondary damage.

For a comprehensive overview of HS, its causes, and full treatment options, see the HS condition guide.

The #1 Rule: Stop Scrubbing

Before anything else, understand what not to do. Scrubbing HS-affected skin is one of the most harmful things a patient can do. Mechanical abrasion — with washcloths, exfoliating gloves, body scrubs, loofahs, or even vigorous towel-drying — increases follicular trauma, disrupts the skin barrier, and triggers inflammation that feeds directly into the HS cycle.

The same applies to chemical exfoliants:

• AHAs (glycolic acid, lactic acid) — too irritating for inflamed, barrier-compromised HS skin
• BHAs (salicylic acid) — while technically a comedolytic, it is not appropriate for use on active HS lesions; the acid irritation outweighs any potential follicular benefit
• Physical scrubs — coarse particles cause microtears that worsen follicular damage

Gentle contact with the skin using the hands or a soft cloth, rinsed well and patted dry (not rubbed), is the correct approach.

Daily Cleansing: What to Use

The choice of body wash is not cosmetic for HS patients — it is a functional decision with clinical evidence behind it.

Antiseptic/Antibacterial Washes

Chlorhexidine 4% solution (e.g., Hibiclens) is a surgical-grade antiseptic that kills a broad spectrum of bacteria on the skin surface. It is used in HS dermatology protocols to reduce the bacterial load in affected intertriginous zones. Apply to affected areas, leave briefly on the skin, then rinse thoroughly. Avoid mucosal surfaces (eyes, ears, genitals directly). The 4% concentration is appropriate; do not use full-strength products in concentrations above 4% on sensitive skin without clinician guidance.

Benzoyl peroxide (4%–10%) body wash reduces Cutibacterium and Staphylococcal species on the skin surface. It is an accessible OTC option, widely recommended by dermatologists for HS skincare, and can be used daily or on alternate days depending on skin tolerance. Note that benzoyl peroxide bleaches fabric — rinse thoroughly, or use dark towels and old clothing.

Zinc pyrithione body wash is a gentler antimicrobial and antifungal option that some HS patients tolerate better than chlorhexidine or benzoyl peroxide, particularly those with sensitive surrounding skin. It is useful for routine maintenance when active lesion count is low.

Sodium hypochlorite (bleach) wash at 0.006% (e.g., CLn BodyWash) has been evaluated in a published real-world study of 145 HS patients across all Hurley stages. All measured symptoms — pain, redness, swelling, drainage, itching, and odor — improved significantly by week four, with pain showing the greatest reduction (average score 3.52 → 1.62, p<0.001). Over 60% of participants reported fewer and shorter flares. 88.8% said they would recommend it. The "dab method" — applying the wash directly to an active lesion and leaving it for up to 24 hours — showed even greater benefits for acute symptoms.

How to Use Antiseptic Washes

1. Apply the wash to affected skin areas using hands (no scrubbing tools)
2. Lather gently and leave on for 30–60 seconds before rinsing (follow product instructions)
3. Rinse thoroughly with warm (not hot) water
4. Pat dry gently with a clean, soft towel — do not rub
5. Apply any prescribed topical medications (e.g., clindamycin 1%) to affected areas while skin is dry

What to Avoid in a Cleanser

Moisturizers and Emollients

HS-affected skin — and the surrounding skin exposed to drainage, dressings, and topical treatments — benefits from regular moisturization to preserve barrier function.

What to Look For

Choose a moisturizer that is:

• Fragrance-free (not just unscented — "unscented" products can still contain masking fragrances)
• Non-comedogenic — labeled as such; avoid heavy occlusives like pure petrolatum in actively folded skin areas where it may trap heat
• Free of alcohol, dyes, parabens, and essential oils
• Formulated for sensitive skin — cream or lotion format rather than a body butter with heavy fragrant oils

Brands that dermatologists consistently recommend for HS patients because they formulate to these standards include:

• CeraVe — Moisturizing Cream or Lotion; contains ceramides and hyaluronic acid, designed for barrier repair
• Cetaphil — Moisturizing Cream; minimal ingredient list, widely tolerated
• Vanicream — Moisturizing Skin Cream; formulated specifically to exclude the most common contact irritants

These are general-purpose sensitive-skin formulations, not HS-specific products. The value is what they exclude, not any active ingredient they contain.

When and Where to Apply

Apply moisturizer to surrounding healthy skin, not onto active open lesions or draining wounds. For skin folds specifically, use a thin layer to avoid creating a warm, occluded environment that promotes bacterial growth. If in doubt, apply to the margins of affected areas rather than directly onto active inflammation.

Deodorant and Antiperspirant for HS

Deodorant choice is a significant practical issue for most HS patients, given the axillary predominance of disease. Research on deodorant tolerability in HS patients shows a clear pattern:

• Solid stick deodorants are the worst tolerated: 52% of users report all deodorant products worsen their HS, and 24% rate solid sticks specifically as "very harmful." The combination of waxy solid texture, fragrance in most formulations, and mechanical friction during application contributes to follicular trauma.
• Spray deodorants are the best tolerated in the same research cohort, rated helpful by 31% of users — still modest, but meaningfully better than other formats.
• Topical antimicrobials (chlorhexidine solution, benzoyl peroxide wash) used as part of the daily cleansing routine provide odor control by reducing bacterial burden — often more effectively than conventional deodorants in affected axillae.

What to Look For in a Deodorant

Choose a spray or roll-on format (avoid heavy roll-on ball friction) that is:

• Alcohol-free
• Fragrance-free
• Baking-soda-free (sodium bicarbonate irritates skin; it is a common "natural" deodorant ingredient to avoid)
• Dye-free and paraben-free
• Aluminum-containing (if an antiperspirant is needed) — aluminum salts are the active antiperspirant ingredient and are not a known HS trigger; they help reduce sweating that aggravates intertriginous maceration

If sweating significantly worsens your HS, discuss botulinum toxin injections with your dermatologist — they temporarily reduce axillary sweating for 4–6 months and are sometimes offered as a procedure for HS patients with hyperhidrosis contributing to flares.

Hair Removal on HS-Affected Skin

Hair removal in affected areas is a complex issue because follicular trauma from hair removal can trigger flares, yet unwanted hair in intertriginous zones is a common concern.

If shaving is the only option, the AAD recommends: wash the area with antibacterial soap first, apply a gel-to-foam shaving gel (not a dry shave), use a sharp blade, and shave with the grain of hair growth to minimize follicular trauma.

Wound Care for Active Lesions

Active, draining HS lesions require more than standard skincare — they need wound management.

Managing Drainage and Odor

• Warm compresses applied for 10 minutes several times a day relieve pain and encourage natural drainage. This is among the highest-ranked interventions in dermatologist wound care surveys (recommended by 76% of clinicians).
• Diluted white vinegar compress: Soak a clean cloth in a 1:4 solution of white vinegar and water; apply to active lesions for 10–15 minutes. The mildly acidic pH inhibits bacterial growth and significantly reduces odor.
• Sodium hypochlorite wash (0.006%) used as a dab method (applied to active lesions and left for up to 24 hours) showed significant patient-reported improvements across all active lesion symptoms in published research.
• Do not squeeze or pop nodules — internal rupture accelerates sinus tract formation.

Dressings

For lesions that actively drain, protecting clothing and surrounding skin with appropriate dressings is essential for quality of life and preventing secondary infection. Dermatologist surveys show:

• Abdominal pads — the most commonly recommended dressing (80% of dermatologists); highly absorbent, available at any pharmacy
• Gauze pads — recommended by 76%; good for smaller lesions or as inner layer
• Menstrual pads or panty liners — recommended by 52% for axillary and groin areas; practical, discreet, and widely available

Change dressings at least once daily, or more frequently if drainage is heavy. Follow any specific wound care plan your dermatologist has prescribed.

Clothing and Environmental Adjustments

Mechanical friction is a direct contributor to follicular trauma in HS. Clothing choices can meaningfully reduce flare frequency:

• Loose-fitting garments over affected areas — avoid tight waistbands, underwire bras, and tight jeans that press or rub against skin folds
• Natural, breathable fabrics (cotton, bamboo) over synthetic fabrics that trap heat and moisture
• Seamless underwear and "boy shorts" style undergarments for groin disease — recommended by approximately half of dermatologists in wound-care surveys
• Wireless bras with thick fabric bands for inframammary disease — reduce both friction and heat accumulation
• Moisture-wicking fabrics during exercise or hot weather
• Stay cool and avoid excessive sweating: Heat and sweating promote maceration of intertriginous skin. Limit intense outdoor activity in peak heat; use air conditioning; choose cooler hours for exercise.

Skincare During Medical Treatment

If you are on medical treatments for HS, your skincare routine needs to account for these interactions:

On topical clindamycin 1%: Apply to dry, clean skin after your antiseptic wash. Do not apply other active products (AHAs, retinoids, benzoyl peroxide) to the same areas at the same time — this is unnecessary and can increase irritation.

On oral antibiotics (tetracyclines, doxycycline): Use SPF 30+ daily on all exposed skin. Doxycycline increases photosensitivity significantly, and sun exposure should be minimized during the course.

On biologics (adalimumab, secukinumab, bimekizumab): Continue the antiseptic wash routine; biologics do not replace surface hygiene. Report any new skin infections or unusual lesions to your dermatologist promptly.

After procedures (deroofing, I&D, wide excision): Follow your surgeon's specific wound-care protocol exactly. Do not apply commercial skincare products to surgical wounds until healing is confirmed.

What to Tell Your Dermatologist About Your Skincare

At your dermatology appointments, proactively disclose:

• Every product you use in affected areas (cleansers, deodorants, shaving products, moisturizers)
• Any product that appears to worsen lesions or trigger flares
• Your hair removal method
• Any wound-care products you are self-managing

Some seemingly innocuous products — "natural" deodorants with baking soda, tea tree oil-containing washes, or fragrant body oils — are common but non-obvious triggers that a dermatologist can help identify and eliminate from your routine.

The Evidence Gap: What We Don't Know Yet

It is important to be honest about the limits of HS skincare evidence. Unlike in acne or rosacea, there are no large randomized controlled trials comparing specific skincare regimens in HS. Most recommendations for cleansers, moisturizers, and wound-care adjuncts are based on:

• Expert consensus from HS specialist dermatologists
• Patient surveys (such as the deodorant and hair removal tolerability research)
• Small real-world studies (such as the sodium hypochlorite wash data)
• Extrapolation from wound-care and barrier-skin research

This does not make the recommendations wrong — it means they should be interpreted as supportive adjuncts to evidence-based medical treatment, not substitutes for it. A dermatologist remains the essential partner in an HS management plan.