Hidradenitis suppurativa (HS), also known as acne inversa, is a chronic, inflammatory skin disease. People with HS develop acnelike lesions in areas of the body that have high concentrations of apocrine sweat glands and hair follicles, such as the buttocks, armpits, and groin. For many people, HS also affects the skin on or under the breasts, causing painful nodules or tunnels (skin tracts).

Here is what you need to know about HS on and under the breasts, including how symptoms may progress and can be managed.

What Is It Like to Experience HS on and Under the Breasts?

Many people develop HS on or under their breasts. For some, this is where their journey with the skin condition begins. As one myHSteam member shared, “Under my breasts is where mine started as a kid.”

Some people with HS on their breasts also have it on other areas: “My problem areas are under my arms, breasts, and groin area,” wrote one member.

Still others find that HS develops on their breasts later, after appearing elsewhere. “This spot so far is the worst and the first time I’ve had it under my breast,” shared one member.

Like that member, many people find that HS on their breasts is worse than it is in other locations. “I’ve had four [lesions] removed from my breasts,” wrote one member. “It was awful.” Another added, “I’ve been dealing with an outbreak on my breast all week. I’ve had so much pain. Haven’t been feeling the best.”

Symptoms of Hidradenitis Suppurativa on and Under the Breasts

The symptoms of HS vary among individuals and depend on the type and severity of HS, as well as the area of skin affected. The Hurley staging system is used to characterize HS severity:

• Stage 1 — Single or multiple lesions with minor scarring
• Stage 2 — Single or multiple lesions with some tunneling and scarring
• Stage 3 — Many lesions throughout the entire body with tunneling and scarring

Having a family history of HS can raise a person’s risk of developing the condition, and lesions can be triggered by:

• Smoking
• Menstrual cycle
• Stress
• Excessive sweating
• Weight gain

Early signs and symptoms of HS on or under the breasts include pain, burning, itching, and excessive sweating (known as hyperhidrosis), which may occur 12 to 48 hours before a lesion appears.

Skin lesions that form on or under the breasts can persist for days to months. The lesions can appear as deep, pea-size bumps similar to acne cysts or boils. Larger lesions may burst and drain foul-smelling pus. Eventually, the lesions may leave scars and form interconnecting tunnels under the skin. Sometimes lesions disappear but then reappear.

Treatment for HS on and Under the Breasts

Although there is no cure for HS, several treatment options can ease symptoms and reduce the likelihood that they will come back. Your dermatologist will help create a treatment plan based on the type, location, and severity of your HS lesions. The most commonly prescribed and recommended treatments for mild HS (Hurley stage 1) include:

• Topical agents, such as lidocaine and anti-inflammatories
• Topical antibiotics, such as clindamycin and dapsone
• Over-the-counter pain relievers, such as acetaminophen
• Corticosteroid injection

Moderate and severe forms of HS (Hurley stages 2 and 3) may call for a combination of topical and oral medications and other therapies. Oral options for severe cases include:

• Antibiotics, including tetracyclines such as doxycycline
• Retinoids, such as acitretin
• Anti-inflammatories
• Corticosteroids
• Hormonal medications, such as birth control pills, spironolactone (Aldactone), and finasteride
• Biologic drugs, such as adalimumab (Humira)

Other therapies, including laser hair removal, radiation therapy, and surgery to remove damaged tissue, have shown some benefit for treating moderate to severe hidradenitis suppurativa. Laser hair removal may also be helpful for people with mild HS.

In some cases, surgery may be the best option to clear HS on or around the breasts. “I had a recurring abscess on my breast cut open today,” wrote one member, “and they cleaned out the sinus tracts, as well as removing dead scar tissue and skin.”

How To Manage HS on and Under the Breasts

Some at-home strategies also can help manage the symptoms of HS on or under your breasts. Several risk factors are associated with the development of HS, and changing certain lifestyle habits or adopting new ones may help control the disease. These include quitting smoking, eating a health diet, and get regular physical activity.

Managing your HS successfully can help reduce discomfort and increase your overall well-being and quality of life.

Quit Smoking

Researchers have found that around 70 percent to 90 percent of people who develop HS also smoke cigarettes. If you currently smoke, stopping may help prevent worsening symptoms and reduce your risk of flare-ups.

Choose the Right Foods

What you eat may affect your HS. Some foods may trigger flare-ups, whereas others can help prevent them. A few small studies have reported that avoiding certain foods may lessen flare-ups and sometimes clear HS. These include:

• Dairy products (cheese, butter, and cow’s milk)
• Sugary foods (soda and candy)
• Brewer’s yeast (found in soy sauce, beer, and wine)

Changing your diet and adopting healthier eating habits may help reduce inflammation, balance hormones and blood sugar levels, and relieve your HS symptoms. Try incorporating more foods that are high in fiber (fruits, vegetables, and whole-grain oats) or contain omega-3 fatty acids (salmon, sardines, and walnuts).

Researchers have suggested that following a Mediterranean or plant-based diet could reduce HS flares. It is important to speak with your dermatologist or primary care provider before changing your diet.

Drop Excess Pounds

Studies have found that being overweight, obese, or having metabolic syndrome is an associated risk for developing HS. A small study found that among people who lost at least 15 percent of their body weight, about 50 percent of participants saw their HS clear up, and about 20 percent had fewer lesions.

Practice Self-Care

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

• Avoid using harsh products (like antiseptics) or potentially irritating cleaning tools (like loofahs, washcloths, or brushes) on the skin. Note that HS is not a result of poor hygiene.
• Steer clear of breakouts on the breasts when shaving, especially if the lesions are close to the armpits.
• Clean the affected area on the breasts daily with antibacterial soap or cleanser.
• Wear loose-fitting clothing to prevent rubbing or friction against the skin.
• Place a warm compress or heating pad on the breasts for 10 minutes at a time.
• Keep your skin cool and dry.

Some members have offered their recommendations for managing HS around the breasts. “Keep a bandage in your bra,” one wrote. “Use Hibiclens to keep it germ-free.”

Speak with your doctor or dermatology professional about the best options for your HS, and consult with them before making any lifestyle changes or adding any HS management approaches to your regimen.

Find Your HS Team

If you or a loved one is living with HS, consider joining myHSteam today. Here, members from around the world come together to ask questions, offer support and advice, and connect with others who understand life with hidradenitis suppurativa.

Do you experience HS on or under your breasts? Have you found a particularly helpful way to relieve the pain and itching? Share your story and tips in the comments below or by posting on your Activities page.