How to Deal With Underarm Hidradenitis Suppurativa

Raise your hand if you’ve got some drama happening in your underarms. If you often get pimples, blackheads, or larger cysts in your armpits, you might be dealing with something more complex than body acne or razor burn. You could have a skin condition called hidradenitis suppurativa, also known as acne inversa, or HS. This skin condition, which involves an overreactive immune system, can crop up in various areas of the body, including the inner thighs, buttocks, breasts, and groin area. Yet your armpits are an extra-prone area of skin. That’s because HS originates within hair follicles and sweat glands—both ample in the underarms—that become clogged and susceptible to bacterial infection. As your body fights the bacteria, this produces those painful HS cysts. While having HS in your armpits might seem like no big deal at first, over time, it can affect your quality of life. People often find themselves feeling self-conscious about wearing sleeveless tops or bathing suits, or worrying about fluid draining from those painful lumps onto their shirt while they’re at work or on a date. Rather than let underarm hidradenitis suppurativa lead to social isolation, educate yourself about some of the most effective ways to deal with this skin disease—starting with the following tips.

Keep your underarms clean and dry.

While it’s a myth that poor hygiene causes hidradenitis suppurativa, strategic skincare habits become extra-important when you have this skin condition. Keeping your armpits dry is key, to minimize blockage of sweat glands. When you shower, avoid scrubbing, which can actually just irritate painful lumps and make things worse. Instead, use your hands to gently lather affected areas using an antiseptic or anti-acne body wash, which will help prevent bacterial infection of hair follicles. Stick to loose-fitting clothing whenever possible, to let your underarms air out and better stay dry.

Be cautious with deodorants.

While deodorant and antiperspirants can be an ally in keeping your armpits dry, when you have underarm hidradenitis suppurativa, they can also be irritants that trigger a future flare-up. It’s best to stick to mild, unscented deodorants designed for sensitive skin; many people with HS also have luck with spray formulas instead of solid (gels tend to be the most irritating). If you haven’t found a product that minimizes irritation, you might opt to skip deodorant entirely and keep your underarm skin clean and dry by using sensitive-skin body wipes a few times a day.

Address abscesses.

People with underarm hidradenitis suppurativa often develop armpit abscesses, painful lumps under the skin that are filled with pus. Usually caused by a bacterial infection, they can appear red and swollen/raised, and lighter in the center (the pus showing through your skin). If not treated, abscesses can lead to pus-filled tunnels under the skin, called sinus tracts. An initial treatment option is to apply a warm compress, which may help the abscess drain naturally. It’s important not to squeeze or try to puncture the abscess, as the bacterial infection can then spread. Instead, seek medical treatment. A dermatologist or other healthcare provider may prescribe antibiotics and/or drain the abscess surgically (a simple procedure that involves local anesthesia but may produce a small scar).

Consider these two tactics.

Note that being overweight or obese is a major risk factor for hidradenitis suppurativa. Some people find that weight loss helps make their symptoms more manageable, or even makes their HS nodules disappear entirely. Another approach that has helped many people put underarm hidradenitis suppurativa into remission: laser hair removal. By zapping hair follicles in the armpits, it removes the chance of future blockage and lesions. Ask your healthcare provider if you’re a good candidate, and keep in mind that it is usually expensive and can take several sessions to see results. That said, it’s an investment that could spare you a great deal of future stress dealing with the always-evolving, often-recurring symptoms of hidradenitis suppurativa.

Visit a dermatologist.

Not all healthcare providers are up to date on the latest treatment options for underarm hidradenitis suppurativa, so it’s worthwhile to book a visit with the dermatology department. For early-stage HS, a dermatologist might prescribe a topical antibiotic, like clindamycin, and a topical corticosteroid cream. Topical retinoids may also be prescribed for underarm hidradenitis suppurativa, as they can fight inflammation while opening clogged hair follicles. Some of the latest treatment options for managing more severe cases of HS include biologics, like infliximab and adalimumab, or the psoriasis drug acitretin.