Managing Hidradenitis Suppurativa Odor

People with Hidradenitis suppurativa (HS) often experience painful and swollen lesions in the armpit, groin, anal, abdominal folds, or breast areas. These lesions or areas of inflammation can turn into cysts or boils filled with pus that can leak or seep.

When these cysts or boils erupt, there may be a noticeable odor. The pus smell comes from the bacteria that have been trapped under the skin inside the boil. These bacteria, called anaerobic bacteria, live without oxygen and can thrive under the skin before they erupt.  

Tunnels or sinus tracts under the skin can appear at the open wound after a cyst burst. Sweat and bacteria become trapped in these tracts and cause infection and inflammation. This can cause more pus and odor. Over time, as these areas heal, they can become hardened or scarred.

In this article, you'll learn the causes of odor and the stages of HS, how to manage the odor, and tips for keeping healthy skin while living with HS.

Why Does Hidradenitis Suppurativa Smell?

Sweat, bacteria, and skin tissues that are infected and inflamed all contribute to the smell that occurs with HS.

HS begins as tender spots of inflammation that look like pimples or boils. Up to half of those with HS will experience a burning sensation, itching, warmth, or excessive sweating within 12 to 48 hours before the spot forms.

A typical painful nodule will last seven to 15 days. During this time, the boil may erupt, creating painful deep abscesses, or holes. The pus that erupts from the boil can be foul-smelling. Draining of the boil may continue for days.  

There are three stages of HS. These stages have varying intensities of HS odor. Treatment is used to prevent or slow progression to the third stage for as long as possible.

The stages are organized by the Hurley scale, as follows:

Hurley stage 1: In this stage, there may be few occurrences of boils or abscesses. Other symptoms such as itching, fatigue, or discomfort in spots on the skin may be more common.

Hurley stage 2: In this stage, boils and abscesses form by themselves or in multiples in various areas of the body. These boils erupt, causing pus to drain from the abscess, which can cause HS odor. As these lesions heal, scar tissue can form.

Hurley stage 3: In stage 3, HS is widespread across the body. Multiple tunnels can form under the skin as can recurrent abscesses and scar tissue. Abscesses will continue to erupt and drain.

In severe cases, the interconnected scar tissue can cause disfiguration or problems with mobility.

Managing Hidradenitis Suppurativa Odor With Proper Skin Hygiene

Managing odor from HS starts with keeping up with your prescribed medication to lessen symptoms and curtail disease progression. Typical medications for HS include:

• Topical and oral antibiotics
• Chemical peeling agents
• Oral retinoids
• Biologics

Taking proper care of your skin can also help prevent flare-ups (times when symptoms worsen). Since boils are the cause of the odor, taking steps to prevent or minimize their appearance can help with HS odor.

Avoid soaps with irritants and harsh chemicals to help reduce irritation. Some dermatologists (physicians specializing in conditions of the skin, hair, and nails) may recommend that you use a wash with benzoyl peroxide and avoid types of antiperspirants.

Certain ingredients in products like antiperspirants are known irritants. Deodorants that contain aluminum salts are known to aggravate HS.

Shaving can also irritate the skin due to the friction that occurs between the blade and the skin. Avoiding shaving by trimming hair instead can help avoid this friction.

Preventing skin abrasions can help with HS skin health as well. Being gentle with the skin while cleansing is important. Avoid loofahs or other abrasive washing methods.

Finding cosmetics and lotions that are free of fragrance and chemicals can also help reduce irritation of the skin.  

When boils do form and erupt, it's important to care for the open wounds properly. Wound care can include:

• Antiseptic washes (kill germs and relieve pain and discomfort)
• Topical antibiotics (medicines that fight bacterial infections)
• Corticosteroid injections (treat inflammation in specific areas of your body)
• Negative pressure wound therapy (special bandage and vacuum-like device used to draw fluid and infection from the wound)
  

Managing Hidradenitis Suppurativa Pus Odor With Lifestyle Changes

While a skincare routine that avoids irritants and properly cares for open wounds is important to managing HS and the pus odor that accompanies the disease, other lifestyle changes have been shown to improve symptoms and delay progression as well.

Lifestyle changes to consider with HS include:

• Quit smoking: Smoking is a known risk factor for HS. Quitting smoking can help delay the progression of the disease and improve symptoms.
• Maintain a healthy weight: Obesity is also known to worsen HS by increasing the probability of skin-to-skin friction and friction between skin and clothing. Losing weight can help avoid this.
• Wear loose clothing: Wearing loose-fitting clothing can help prevent abrasions that might occur due to clothing rubbing against the skin.
• Consider dietary changes: While more research is needed, one study found that eliminating dairy helped with HS symptoms.
• Take care of yourself: Self-care is an important part of living with HS. While taking care of your skin is imperative, so is taking care of your mental health. Find a support group or talk to a qualified professional to help manage stress and deal with emotional challenges.

At-Home Remedies

Though research is ongoing on complementary and alternative medicine (CAM) therapies to treat HS, many have found anecdotal relief through at-home remedies.

When to See a Healthcare Provider

If you're experiencing an increase in HS lesions or boils or their occurrence becomes more frequent, talk to your healthcare provider. A healthcare provider can adjust medications or suggest new treatment options that may work for your situation.

Keeping an open dialogue with your healthcare provider can help manage flare-ups with HS and keep HS from progressing, which can help with HS odor.

Summary

Living with HS can be difficult, but there are ways to manage the disease and recurring lesions. Seeking help from a healthcare provider early on can help prevent excessive scarring and slow progression of the condition.

While it may take some trial and error to determine what works best for you, it's possible to find a skin-care routine that minimizes flare-ups and odor with HS. This may include prescription drugs, magnesium sulfate baths, or swapping lotions and antiperspirants with harsh chemicals for ones that are natural.

A Word From Verywell 

Although HS has no known cure, there are ways to manage flare-ups to minimize its impact on your life. Working with a healthcare provider to establish a skincare routine that reduces irritation and flares can help manage odor that often occurs with HS.