Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that causes 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 bursts. 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 scar.
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.
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 odor from HS starts with keeping up with your prescribed medication to lessen symptoms and curtail disease progression. Typical medications for HS include:
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.
A skin hygiene routine with HS requires careful choices in products and taking actions to prevent skin irritation. Irritation of the skin leads to more flare-ups. In HS, certain factors are known to cause flare-ups and more inflammation and pain around boils.
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:
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:
Though research is ongoing on complementary and alternative medicine (CAM) therapies to treat HS, many have found anecdotal relief through at-home remedies.
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.
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.
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.
While you can’t prevent a boil from draining and creating an odor, keeping a wound clean can help prevent further smells.
The odor from HS occurs when boils erupt or leak and is quite common in the second and third stages of the disease.
Treating body odor from HS requires proper treatment of the disease itself. This can include prescription medications, avoiding skin irritants such as harsh deodorants, and making lifestyle changes, such as quitting smoking.