Hidradenitis suppurativa (HS) is a chronic skin condition. People with HS develop painful lumps in areas of the body like the underarms (armpits), buttocks, and groin.¹ HS can also affect areas of skin that rub against each other, such as below the breasts, in the stomach and genital areas, and on the inner thighs.²

If you struggle with HS under your arms, you are not alone. “I’m in a flare-up right now under my armpits,” a myHSteam member wrote. “It hurts so much.” Although there is no cure for HS, treatments can help you better manage your symptoms and improve your overall quality of life.³

Symptoms of Hidradenitis Suppurativa in the Underarms

Before you notice any lumps under your arms, you may notice itching, burning, or excessive sweating. These symptoms occur for 12 to 48 hours before an HS nodule appears. Not everyone with HS will have these early symptoms.⁴

When you do notice a nodule, it might look like a pimple or boil in your armpit. The nodule may disappear for a while and then return. Over time, individual nodules can merge together and develop into painful abscesses.² Abscesses are filled with pus and can have a strong odor when the fluid drains.⁵

After your wound opens and drains, it may heal and then return. This process of wound healing and then symptoms flaring again can lead to developing sinus tracts, or tunnels, under the skin.² It can also lead to scarring that inhibits movement — and this can be a particular problem for people with symptoms in the armpits.^1,2

HS can be very painful.⁶ “My right armpit is inflamed once again,” a myHSteam member wrote. “I can’t sleep because I’m in so much pain.”

HS can have a tremendous impact on self-confidence and social interactions.⁶ “My HS has always affected my relationships,” shared one myHSteam member. “I avoid being intimate when I have a flare-up. I feel uncomfortable having to explain what’s going on even though it’s not contagious.”

Treatment of Hidradenitis Suppurativa in the Underarms

Several treatment options are available to relieve your symptoms and reduce the chances that your symptoms will come back. Your dermatologist will help create a treatment plan based on your specific situation, including how severe your lesions are and how your disease is affecting you.³ Your doctor may also discuss family planning with you. Certain medications are not appropriate during pregnancy or when breastfeeding.⁶

Your dermatologist may recommend:

• Topical treatments such as antibiotics³
• Oral medications including antibiotics, hormonal treatments, retinoids, and anti-inflammatory drugs³
• Biologic drugs³
• Steroid (or corticosteroid) injections³
• Pain relief medications⁶

Sometimes surgical procedures are used to treat HS. Many people with HS may be treated with medications and procedures. Your dermatologist may recommend one of a few types of procedures:

• Unroofing or deroofing is the removal of the skin covering a sinus tract or abscess.^3,6
• Wide excision removes the entire lesion or sinus tract. This leaves people with a large wound after the procedure. It’s usually done only if medication hasn’t helped.³
• Laser surgery can remove HS lesions. This is generally used only if medications are able to stabilize your condition for a period before the procedure.³

Incision and drainage of abscesses used to be a more common procedure, but it’s not considered effective anymore because the drained abscesses usually return.⁶

Wound Care

Caring for your wounds is an important part of caring for HS under your arms.³ Individual needs and preferences will vary, so it’s best to ask your doctor for guidance.⁷

Many people use products not intended for open wounds, such as menstrual pads.⁸ These options can be cheaper but may be less comfortable than other choices.⁷

Many types of wound dressings are available, such as abdominal pads and hydrofiber dressings. Wound care supplies can be pricey and sometimes hard to find.⁷ Your health insurance may cover wound care supplies. You can ask your doctor for help getting wound care materials through your health insurance provider.⁸

How to Manage HS on the Underarms

Changing certain lifestyle habits or adopting new ones may also help control your skin disease.⁹ Lifestyle approaches include:

• Exercise regularly.⁶
• Quit smoking.⁹
• Eat a Mediterranean diet high in fruits, vegetables, whole grains, and healthy fats.¹⁰
• Avoid potential triggers like dairy and brewer’s yeast (found in soy sauce, beer, and wine).¹⁰

Speak with your dermatologist or primary care provider before making any diet changes.¹⁰

At-Home Recommendations

These at-home tips may help ease symptoms and avoid flare-ups:

• Be very careful if you want to shave your underarms. Wash your skin with an antibacterial soap, and use a protective shaving gel.⁹
• Choose your deodorant carefully. Avoid ingredients like fragrance, alcohol, or baking soda.⁹
• Avoid scrubbing your skin. Aggressive rubbing can cause inflammation, which can make your skin worse.⁹
• Clean your underarms with antibacterial soaps or cleansers. Some of these products are marketed for acne.⁹
• Wear loose-fitting clothing to prevent rubbing or friction against the skin.⁹
• Consider HS-specific clothing brands that are sometimes covered by insurance.⁸
• Hold a warm compress against your underarms to reduce pain. This might also help drain wounds.⁹
• Keep your skin cool and dry. Sweating can make HS symptoms worse.⁹

Speak with your healthcare provider about the best options for your HS before making any lifestyle changes or adding these at-home recommendations to your daily routine.