Hidradenitis suppurativa (HS), or acne inversa, is a painful skin condition that can affect all aspects of life. In addition to physical symptoms, HS may impact your relationships, self-esteem, and ability to travel or participate in events and activities.

While HS itself can be stressful, stress also acts as a risk factor for HS by promoting inflammation and high cortisol (stress hormone) levels. As a result, many people find themselves trapped in a cycle of feeling stressed out and experiencing HS flare-ups as a result.

Members of myHSteam have described their frustrations, with one member saying, “I’m going through something right now that's causing me a great deal of stress. Unfortunately, with the stress, a flare-up is starting after months of being clear. I’m feeling so discouraged. 😔”

Learning to keep stress under control is an essential part of considering hidradenitis suppurativa treatment options and self-care. Although it seems easier said than done, you can take steps to get a better handle on your stress levels. Here are 10 ideas to get you started.

1. Express Gratitude

It’s not always easy to see the positive in life when you’re dealing with the symptoms of HS. Challenging yourself to think of something you’re grateful for, even something small, can help turn your stress around.

The physical effects of stress are related to our perception of stress. Studies show that two people can experience the same situation but respond to it differently, depending on how much they internalize stress. Keeping stress in perspective by focusing on what you’re grateful for is one way to limit the physical impact of triggers.

2. Put Yourself First

“I work at a hospital, and for 15 years, I’ve always put patients’ needs in front of my own,” said one member of myHSteam. “I also love my coworkers, and I feel like I am letting them down because I have to be out of work every time I have an abscess. But I have learned that if I don’t let go and take care of my health, I am no good for the patients or my coworkers.”

When you have a chronic health condition, you need to be “selfish” sometimes. Prioritizing your rest, privacy, or time off is critical for recovery from a flare. You’ll need to set boundaries to protect your health, including respectfully declining invitations or using your sick days when needed.

3. Seek Common Ground

When living with the challenges of HS, it can seem like no one else understands what you’re going through. Even if you don’t know someone else with the same skin disease, you can try relating to others in different ways. For example, individuals with chronic pain or other skin conditions may share similar struggles.

Look for opportunities to connect by focusing on what you have in common rather than what sets you apart. You might be surprised to hear what others share when you start listening more and opening up.

4. Pursue ‘Green and Blue Spaces’

Scientific evidence increasingly points to the mental health benefits of spending time in nature. Exposure to bodies of water (blue spaces) or areas with natural greenery (green spaces) promotes well-being and reduces perceived stress levels and physiological responses to stress.

If you live in an urban environment, you can still improve your quality of life by spending more time in parks and gardens, or even sitting under a tree or near a fountain. Be mindful of your environment and opportunities to enjoy nature when you can.

5. Eliminate Clutter

You may not feel up to it in the midst of an HS flare-up, but try to keep your living space tidy and organized when your HS symptoms are under control. Many types of clutter can build up throughout your home, and these items can quickly become a mental burden. Outdated paperwork, expired food and supplements, clothes you don’t wear, old books and media, gifts you feel obligated to keep, and extra tools or electrical cords you can’t use are just some examples. It’s worth taking time to reduce and recycle clutter that adds to your stress levels, so you can focus on more important things (and people) in your life.

6. Be Creative

Immersing yourself in a creative hobby can give you a much-needed escape from the daily grind. Members of myHSteam have mentioned the benefits of finding helpful distractions. “I’ve come to find that sitting and focusing on a hobby helps distract my mind from the pain,” shared one member.

You can paint, draw, make pottery, write, bake, play an instrument, do puzzles, visit museums, garden, work on home improvement projects, or learn a new language. The idea is to do something you find meaningful and productive that provides a sense of fulfillment.

7. Try Mindfulness Meditation

Lots of people with HS report difficulty sleeping. Maintaining a regular sleep schedule, creating a calming environment for sleep, and avoiding electronics before bed can help, but these habits don’t always fix the problem. In addition to discussing insomnia with a health care provider, you can incorporate mindfulness meditation into your routine to improve your rest.

Studies support the use of mindfulness meditation as a complementary therapy to treat chronic insomnia. Taking a few minutes every night to focus on the present can help you calm the stresses of the day and prepare for a better night’s sleep.

8. Forgive Yourself and Others

If you’re holding on to regrets or resentment, you may only be hurting yourself. Scientists aren’t exactly sure how, but it appears forgiveness reduces the severity of stress and promotes better mental and physical health. Choosing to forgive others doesn’t mean you condone or agree with what they’ve done. It just means you’re letting go of the negative impact it’s having on you. Forgiveness isn’t always easy, so reach out to a supportive person, trusted spiritual leader, or mental health provider for help with the process.

9. Focus on What You Can Change

Stress is often the result of feeling out of control. With HS, it’s normal to get discouraged by the unpredictability of the disease. Even when you avoid triggers and make positive lifestyle changes, it’s not always possible to prevent HS flare-ups. If you believe there’s nothing more you can do to manage HS, it’s time to move toward acceptance and work on what you can control instead.

Write a list detailing the things in life you have control over and the things you don’t. For example, you might not be able to change your medical condition or pain level, but you can control your breathing, the foods you eat, and the way you talk to yourself. Set realistic goals to improve your quality of life, such as calling a friend every weekend, reading one book a month, or developing a financial plan to cut extra expenses. You may find that putting more energy into positive things takes away from the negative aspects of life.

10. Find Professional Help

If stress is too much to handle, you should look for professional help. Ask your primary care provider or dermatologist for a referral, or call your health insurance company for help finding someone in your network. You may be able to meet in person or through a telehealth visit.

In addition to working with you individually, a counselor can help address dynamics with your partner or loved ones. Marriage counseling, family therapy, and other types of group programs can facilitate better communication and stronger relationships.

Talk With Others Who Understand

On myHSteam, the social network for people and their loved ones living with hidradenitis suppurativa, more than 32,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Do your health care providers or family members help you with stress management? Have you found any HS support groups or other resources? How do you handle the mental health effects of life with a chronic skin condition? Share your experience in the comments below, or start a conversation by posting on your Activities page.