How to Create a Skincare Routine for Hidradenitis Suppurativa - By Jessica Lee

Caring for your skin is critical to managing Hidradenitis Suppurativa (HS), a chronic inflammatory condition affecting hair follicles. Establishing a consistent and effective skincare routine can help minimize flare-ups, reduce discomfort, and promote overall skin health. In this blog post, I’ll guide you through the essential steps to build a skincare routine tailored specifically for Hidradenitis Suppurativa.

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Choose the Right Cleansers for Hidradenitis Suppurativa

Opt for Mild, Antibacterial Soaps: Start your skincare routine with a gentle, antibacterial soap that cleanses without irritating the skin. Look for products free from harsh chemicals, fragrances, and dyes, as these can worsen HS symptoms. Soaps containing ingredients like benzoyl peroxide or tea tree oil may offer additional antibacterial benefits.

In my post, 7 Best Soaps for Hidradenitis Suppurativa I share how, through trial and error, I discovered some cleansers that helped with maintaining my HS symptoms, and some of my all-time favorites include PanOxyl Acne Foaming Wash (Benzoyl Peroxide 4% or 10%), which is effective in reducing bacteria on the skin. It can be a bit harsh, so start with the lower concentration to see how your skin reacts and then, over time, build up to the higher concentration.

Hibicleanse Antimicrobial Skin Cleanser is another one of my favorites. It is a medical-grade skin cleanser with the active ingredient chlorhexidine gluconate, a powerful antiseptic. It is widely used in healthcare settings and for personal hygiene, especially for individuals prone to infections, like those with

Hidradenitis Suppurativa (HS), which works to effectively reduce the bacterial load on the skin.

My favorite part is that this cleanser continues to kill germs on the skin for up to 24 hours after application. It can be very drying on the skin, so moisturizing after use is very important, but more on that later.

Consider pH-Balanced Products: The skin’s natural pH is slightly acidic, which helps maintain its barrier function. Using a pH-balanced cleanser can help preserve this barrier and prevent irritation. Some note-worthy cleansers that keep the skin’s natural pH balance include Cetaphil Gentle Skin Cleanser.

This classic, soap-free cleanser is mild and suitable for all skin types, including sensitive skin. It helps cleanse without stripping the skin of its natural oils. Neutrogena Ultra Gentle Hydrating Cleanser is another great option. It is a fragrance-free, creamy cleanser that is ideal for sensitive skin and helps remove impurities without irritation.

The Cleansing Process

Use Lukewarm Water: Hot water can strip the skin of its natural oils, leading to dryness and irritation. Instead, use lukewarm water to cleanse the affected areas gently. This method helps to open pores and remove debris without causing additional stress to your skin.

Be Gentle: When washing your skin, use your hands or a soft washcloth. Avoid scrubbing the skin, as this can cause friction and worsen inflammation. Apply the cleanser in a gentle, circular motion to ensure the product is distributed evenly.

Focus on Affected Areas: Pay special attention to areas where HS lesions commonly appear, such as the underarms, groin, buttocks, and under the breasts. Thoroughly cleanse these areas to remove sweat, bacteria, and debris that can contribute to flare-ups.

Drying the Skin

Pat, Don’t Rub: Gently pat your skin dry with a clean, soft towel after cleansing. Avoid rubbing, as this can irritate sensitive skin and potentially spread bacteria to other areas.

Use Separate Towels: If possible, use a separate towel for HS-affected areas to prevent cross-contamination. Make sure towels are cleaned and sanitized regularly to maintain cleanliness.

Moisturizing the Skin

Choose the Right Moisturizer: Moisturizing is crucial in maintaining the skin’s barrier function and preventing dryness. Opt for a non-comedogenic, fragrance-free moisturizer that won’t clog pores or irritate your skin. Ingredients like aloe vera, ceramides, and hyaluronic acid can help soothe and hydrate.

Apply After Cleansing: For best results, apply moisturizer immediately after cleansing while your skin is still slightly damp. This step helps lock in moisture and creates a protective barrier. Some of my favorite moisturizers are CeraVe Moisturizing Cream, Vanicream Moisturizing Cream, and Eucerin Advanced Repair Cream. Pro Tip: Remember, a little goes a long way.

Incorporate Medicated Treatments

Topical Medications: If your dermatologist has prescribed topical treatments such as antibiotics, retinoids, or anti-inflammatory creams, apply them as directed after moisturizing. These treatments can help reduce inflammation, prevent infections, and manage symptoms.

Spot Treatments: For active lesions, consider using spot treatments containing ingredients like salicylic acid or sulfur, which can help reduce the size and severity of flare-ups. Differin Gel (Adapalene 0.1%): A retinoid-based treatment can help reduce inflammation and prevent future breakouts. Mario Badescu Drying Lotion: Contains salicylic acid, sulfur, and zinc oxide to help dry out active lesions overnight.

Tea Tree oil is another great option because it is a natural antibacterial and anti-inflammatory oil used to help reduce the size and discomfort of HS lesions. Pro Tip: Make sure you always use a carrier oil with essential oils. An excellent carrier oil option for tea tree oil that does not clog pores is jojoba oil. Jojoba oil is non-comedogenic, meaning it won’t block pores, and it closely mimics the skin’s natural sebum, making it an excellent choice for sensitive or acne-prone skin.

Regular Exfoliation

Gentle Exfoliation: This step, to me, is honestly the most important. Exfoliating your skin can help remove dead skin cells and prevent clogged pores, reducing the likelihood of HS flare-ups. However, choosing a gentle exfoliant that won’t irritate your skin is essential. Avoid harsh scrubs or exfoliants with large, rough particles.

Instead, opt for choices such as Paula’s Choice Skin Perfecting 2% BHA Liquid Exfoliant: A gentle, leave-on exfoliant with salicylic acid that helps unclog pores and reduce inflammation and The Ordinary Lactic Acid 5% + HA: A mild exfoliating serum that helps remove dead skin cells and improve skin texture without causing irritation.

Frequency: Exfoliate at most once or twice a week. Over-exfoliation can strip the skin of its natural oils and worsen inflammation. Trust me, it hurts and is very painful, so avoid it at all costs.

Additional Considerations

Avoid Triggers: Certain activities or products can trigger HS flare-ups. Pay attention to how your skin reacts to specific cleansers, lotions, or environmental factors, and adjust your skincare routine accordingly.

Shaving: If you need to shave areas affected by HS, use a sharp, clean razor and a gentle shaving cream or gel. Shave in the direction of hair growth to minimize irritation and avoid shaving over active lesions.

Clothing: Wear loose-fitting, breathable clothing made from natural fabrics like cotton after cleansing. Tight or synthetic clothing can trap moisture and heat, leading to irritation and flare-ups.

Adapt Your Routine to Your Needs

Morning and Evening Routines: Depending on your skin’s needs and lifestyle, you may find it helpful to cleanse twice a day—once in the morning and once before bed. For example, in the mornings, I go for the Cerave Hydrating Cleanser, and in the evenings, after a long, active day, I go for the Hibicleanse Antimicrobial Skin Cleanser. However, if your skin feels dry or irritated, you might reduce cleansing to once a day or every other day, focusing on maintaining a balance.

Listen to Your Skin: HS can be unpredictable, and what works one day might not work the next. Be flexible with your skincare routine and make adjustments based on how your skin feels and reacts.

Building an effective skincare routine for Hidradenitis Suppurativa is a vital step in managing the condition and promoting healthier skin. By choosing the right products, practicing gentle cleansing techniques, and staying aware of your skin’s needs, you can reduce the frequency and severity of flare-ups. Remember, consistency is key, and with time, a well-thought-out skincare routine can become a powerful tool in your HS management strategy. Take care of your skin, be patient with the process, and remember that small, daily actions can lead to significant improvements over time.