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Why Hidradenitis Suppurativa Smells Bad During a Flare

Medically reviewed by Steven Devos, M.D., Ph.D.
Written by Bora Lee, Ph.D.
Posted on August 4, 2023

Unpleasant odors from hidradenitis suppurativa (HS) flares can be a source of stress and frustration for myHSteam members. “Nothing has seemed to help with the odor,” one member commented.

If you need help with managing odors from leaking wounds, you can try a few techniques to reduce the smell and the stress that comes with it. Read on to learn what causes the HS smell and ways you can curb it.

What Causes the HS Odor?

Hidradenitis suppurativa, also known as acne inversa, is caused by chronic inflammation of the hair follicles. In this skin condition, hair follicles get clogged with keratin (a protein in skin, hair, and nails), sweat, and bacteria. This leads to the development of cysts or abscesses that are filled with pus — a mixture of dead white blood cells, skin cells, and bacteria or fungi. If these lesions burst, pus can drain from the open wound and cause an odor.

What Does HS Odor Smell Like?

HS lesions most often form near the sweat glands, such as the armpits, groin, and inner thighs. People who notice a smell coming from HS lesions often describe it as a strong foul odor. “I used to have the smell of blood or sweat that would make me want to dig a hole and stick my head in it,” wrote one myHSteam member.

“It’s awful. It stops me in my tracks when I catch a whiff of myself. It’s a very real and pungent smell,” shared another member.

The smell coming from HS lesions may cause embarrassment and anxiety, negatively affecting a person’s quality of life. People with HS may experience loneliness, depression, low self-esteem, and social isolation that can make forming personal relationships and participating in social activities difficult. What’s more, the stress caused by worrying about the odor can trigger HS breakouts.

What Makes the HS Odor Worse?

HS usually occurs in cycles, with lesions healing and then becoming inflamed again when something triggers a flare. As with other symptoms of HS, the related smell becomes more intense during an outbreak.

In severe cases of HS, many abscesses deep under the skin connect and form tunnels (also called sinus tracts) that contain pus. When these pus-filled tunnels drain, it results in a strong smell that some people with HS experience during flare-ups. HS symptoms, including the smell, sometimes worsen before menstrual periods.

How Can You Manage the HS Smell?

Although you can’t prevent an odor from HS lesions, you can take several steps to curb it. Cleansing skin gently, applying effective dressings, and avoiding flares are key parts of a plan to manage the HS odor.

Clean Your Skin Gently

HS typically affects areas of the body with skin folds where sweat can get trapped and bacteria can grow. This may cause odor and skin irritation, possibly triggering an outbreak.

Keeping the affected areas clean with regular washing can help manage the HS smell. Avoid scrubbing and using harsh, scented soaps, which can irritate the skin and lead to flare-ups. Instead, use a gentle cleanser — many of the best options can be purchased over the counter.

Use Antiseptic Wash

Cleansing the affected areas with antiseptic wash daily helps reduce the growth of bacteria on your skin’s surface that can contribute to odor. An acne cleanser that contains salicylic acid, benzoyl peroxide, or zinc pyrithione can be part of your skin care routine, or you could try an antibacterial soap such as Hibiclens or Hibiscrub. Applying diluted white vinegar to HS lesions before dressing them can also help reduce the odor.

Many members of myHSteam affirmed the effectiveness of a good cleansing routine, sharing comments such as these:

  • “Best stuff to use is Hibiscrub. Surgeons use it and it’s scent-free.”
  • “I cannot use deodorant, but antibacterial soap helps a lot.”
  • “I wash my flare areas with 10 percent PanOxyl (benzoyl peroxide) and let it sit for a minute.”

Use Absorbent Dressing

Placing absorbent pads in affected areas to catch the pus draining from abscesses and tunnels can reduce the strong smell caused by HS. Absorbent dressings come in different strengths, and menstrual pads also can be used effectively for this purpose. However, avoid dressings with strong adhesive borders, which can irritate the skin around HS lesions.

Members of myHSteam have discussed the importance of covering HS lesions to control the smell. “The odor was from when an abscess is opened and needs to drain. The pus does have an odor. In fact, when I went and got one lanced last week, I actually had to ask the doctor what that smell was,” one member wrote. “The thing that helped with the smell was to keep it clean and covered. Once it drained entirely, the smell went away and the wound healed itself.”

Wear Loose-Fitting, Breathable Clothing

Friction caused by tight clothing can cause irritation and the rupture of HS abscesses, leading to draining. Synthetic fabrics also trap sweat more than natural fabrics, which are more absorbent. Wearing loose-fitting clothes made of a natural fabric can help reduce HS lesion irritation and odor.

Choose Your Deodorant Carefully

Deodorants and antiperspirants can help control HS smell and body odor from underarm perspiration. However, some chemicals and fragrances in these products can trigger a flare-up. Avoid products that contain alcohol, baking soda, parabens, dyes, or fragrances. Spray deodorants are recommended because they tend to be less irritating than solid sticks.

Keep Flares at Bay

Symptoms of HS, including odor, can worsen during a flare-up, so avoiding triggers that bring on outbreaks is an important part of managing HS and its odor. The following lifestyle-related tips can help you avoid HS triggers:

  • Stop smoking — Smoking is highly linked with the development of HS and flares.
  • Reduce stress — Both stress in general and the stress of living with HS can trigger flares.
  • Avoid overheating — Sweating and getting too hot often trigger HS outbreaks.

Ask Your Doctor About Antibiotic Treatment

Topical antibiotics such as clindamycin can be used to treat HS lesions and prevent secondary infections that could lead to more pus production and draining. In some cases, an oral antibiotic such as minocycline or tetracycline, or a combination of topical and oral antibiotics, can be used.

When Should You Talk to a Doctor About HS Odor?

If a strong smell coming from your HS lesions begins to affect your daily activities and mental health, reach out to a dermatologist who can help you understand your treatment options. Your health care provider can guide you to the most effective treatment plan, helping you minimize HS odor and regain your confidence in daily activities and social situations.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 34,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Have you experienced a bad smell coming from your HS wounds? What treatments or strategies have helped? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Posted on August 4, 2023
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Steven Devos, M.D., Ph.D. received his medical degree and completed residency training in dermatology at the University of Ghent, Belgium. Learn more about him here.
Bora Lee, Ph.D. has more than 10 years of translational research experience in reproductive medicine and women’s health, with a focus on fertility and placental health. Learn more about her here.

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