Hidradenitis Suppurativa Under the Arms: Pictures and Treatment | myHSteam

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Hidradenitis Suppurativa Under the Arms: Pictures and Treatment

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Imee Williams
Posted on April 12, 2022

Hidradenitis suppurativa (HS) (or acne inversa) is a chronic, inflammatory skin condition. People with HS have small, painful acne-like lumps in certain areas of the body like the underarms (armpits), buttocks, and groin. HS can also affect areas of skin that rub against each other such as below the breasts, stomach fold, genital area, and inner thighs. The underlying cause of HS is not known.

If you have HS under your arms, you are not alone. More than 7,000 members on myHSteam experience HS in this area. Although there is no cure for HS, treatments can help you better manage your symptoms and improve your overall quality of life.

Symptoms of HS on the Underarms

The symptoms of HS vary in every person and depend on the type of HS, the severity of the disease, and the area of skin affected. Symptoms can often be triggered by smoking, menstrual cycle, stress, excessive sweating, or weight gain.

Hidradenitis suppurativa of the underarm can look similar to other skin conditions and is sometimes misdiagnosed as acne, boils, cysts, or inflamed hair follicles. (DermNet NZ)

Early signs and symptoms of HS on the underarms include inflamed hair follicles (folliculitis), painful red bumps, itching, burning sensation, and excessive sweating (hyperhidrosis). These symptoms occur for 12 to 48 hours before the onset of the skin lesion.

Skin lesions can appear on the underarms and can last for days to months. The skin lesions can appear as a deep pea-sized bump similar to an acne cyst or boil. Some of the skin lesions will grow in size and burst, draining out foul-smelling pus. Over time, skin lesions may leave scars and form tunnels under the skin that interconnect with each other. Skin lesions may go away and then reappear.

HS under the arms can be very painful. “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 relationships. “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.”

Moderate and severe forms of HS on the underarms may need combined medical and surgical therapy to help manage the disease. If left untreated, it can grow deeper into the tissue and lead to painful fluid-filled lumps or thick scars. (DermNet NZ)

Treating HS on the Underarms

There are several treatment options available to lessen your symptoms and reduce the rate of recurrence. Your dermatologist will help create a treatment plan based on the type of lesions, the area of skin affected, and the severity of HS. The most commonly prescribed and recommended treatments for mild underarm HS include:

One member from myHSteam shared their experience with steroid injections. “I had cysts in both my armpits that were the size of baseballs. My dermatologist treated them with a steroid injection. It helped to reduce the size, and I was able to move my arm again without the help from someone.”

Moderate and severe forms of HS on the underarms may require a combination of topical and oral medications and surgery. Some oral medications include:

  • Oral antibiotics (such as clindamycin, rifampin, or gentamicin)
  • Oral retinoids (such as acitretin, isotretinoin, and alitretinoin)
  • Oral anti-inflammatories
  • Corticosteroids
  • Hormonal medications (such as birth control pills, spironolactone, or finasteride)
  • Tumor necrosis factor-alpha inhibitors (such as adalimumab, sold as Humira)

Common surgical procedures include:

  • Incision and drainage of abscess
  • Deroofing — Removal of the skin covering an abscess or sinus tract
  • Wide excision — Removal of the entire lesion or sinus tract

One myHSteam member shared their experience with their surgical treatment. “I had deroofing done on one of my abscesses in my underarm. I didn’t feel any pain during the procedure. My skin healed nicely, and I haven’t had recurring abscesses or sinus tracts in my underarm.”

Other therapies such as laser hair removal (carbon dioxide laser therapy), low-dose radiation therapy, and Botox injections have shown to be of some benefit for treating moderate to severe HS. Laser hair removal may also benefit people with mild HS.

How To Manage HS on the Underarms

Changing certain lifestyle habits or adopting new ones may also help control your skin disease. Some lifestyle changes include:

  • Exercise regularly
  • Get enough sleep
  • Reduce stress
  • Quit smoking
  • Eat a diet high in fiber from fruits, vegetables, and whole grains
  • Eat foods high in omega-3 fatty acids (salmon, sardines, and walnuts)
  • Avoid potential triggers like dairy, sugary foods, brewer’s yeast (found in soy sauce, beer, and wine), and processed foods

Speak to your dermatologist or primary care provider before making any lifestyle changes.

At-Home Recommendations

In the early stages of HS, you may be able to manage your flare-ups by following these at-home tips:

  • Don’t shave near breakouts on the underarms.
  • Avoid harsh, fragranced products on the skin (lotions, perfumes, or body sprays).
  • Avoid using cleaning tools on the skin (loofahs or brushes).
  • Clean the underarms daily with antibacterial or antiseptic soap or cleanser to prevent bacterial infections.
  • Wear loose-fitting clothing to prevent rubbing or friction against the skin.
  • Use a warm compress or heating pad on the underarms frequently.
  • Keep your skin cool and dry.

Some members on myHSteam also shared their at-home tips:

  • “I soak a clean washcloth in diluted white vinegar and apply it before I dress my wound to reduce the odor.”
  • “Ice packs and lidocaine help when I have mild pain.”
  • “Hot baths soothe my skin and relax my mind. I add a little tea tree oil to my bath for extra antibacterial benefits.”

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

Find Your Team

Living with HS can be difficult, but you are not alone. On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 24,000 members come together to ask questions, give advice, and share their experiences with others who understand life with hidradenitis suppurativa.

Do you have HS on the underarms? Share your thoughts in the comments below or by posting on myHSteam.

Posted on April 12, 2022
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Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Imee Williams is a freelance writer and Fulbright scholar, with a B.S. in neuroscience from Washington State University. Learn more about her here.

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