Few things can make you feel as self-conscious as realizing there’s a bad smell that’s coming from you. Whether you forgot to wear deodorant or didn’t brush your teeth, once you notice it, you probably get the urge to fix the issue as soon as possible. But if a vomit-like odor is coming from your skin due to hidradenitis suppurativa (HS), an inflammatory condition of the hair follicles, the solution may not be so simple.

A member of myHSteam asked why their skin might smell like vomit, sparking a discussion about HS body odor and how to manage it. “My armpit’s pus has started smelling like vomit. I suspect it’s because the infection is improving, and my body odor is mixing with the smell of the infection … Please help if you have any input.”

Poor hygiene isn’t always the cause of strong body odor. In this article, we’ll discuss three reasons why your skin might smell like vomit and how to manage it with HS.

1. Bacteria Mixes With Sweat and Gland Secretions

Body odor generally comes from the mix of sweat and bacteria on your skin. The smell can vary based on hormones, diet, or medical conditions.

You might be surprised to learn that sweat itself doesn’t smell. The odor comes from bacteria breaking down sweat. How much you sweat doesn’t always determine how strong the smell is.

During a hidradenitis suppurativa flare, bad smells can result from bacteria breaking down the sweat, apocrine gland secretions, and dead skin. Apocrine glands are sweat-producing hair follicles found in places like the groin area and underarms, where body odor is most common.

When bacteria break down sweat and gland secretions, they produce volatile organic compounds (VOCs). These VOCs, which are fatty acids, create the odor you smell.

A vomit-like body odor can come from VOCs called short-chain fatty acids, including butyric, propionic, or acetic acid.

2. Bacterial Overgrowth

The type of bacteria growing on your skin and how that bacteria interacts with your sweat determines your body odor.

A strong, unpleasant odor can indicate a bacterial skin infection. The bacteria causing the infection can change the chemical makeup of your sweat, making it smell different than usual. People with hidradenitis suppurativa are prone to skin infections, and HS abscesses can be breeding grounds for bacteria.

During a hidradenitis suppurativa flare, apocrine glands become blocked with dead skin cells and sweat, forming cysts. These cysts can become infected, turning into abscesses. If an abscess bursts, the bacterial infection can spread. Pus from abscesses can collect in tunnels under the skin (called sinus tracts), making it hard to eliminate the odor.

Different areas of skin can harbor different bacteria, so don’t be surprised if one armpit smells worse or different than the other. One myHSteam member shared, “I’ve never smelled like vomit, but the smell is kind of off-putting when I turn my head to the left.”

3. Chronic Inflammation

During an HS flare, areas of skin with apocrine glands become inflamed. While inflammation doesn’t directly cause a vomit-like odor, it drives the development of abscesses and sinus tracts. More abscesses and sinus tracts mean more bacteria, which can worsen body odor. Many HS treatments focus on reducing inflammation to help the skin heal.

Managing Skin Odors

If your skin smells like vomit, it can affect your self-esteem and make you avoid social situations. However, there are ways to manage this odor so it doesn’t impact your quality of life.

Talk to your doctor if you notice a vomit-like smell. Your doctor or dermatologist can recommend treatments and strategies to help you manage HS symptoms, including body odor.

Hygiene Practices

Good hygiene is essential when it comes to managing body odor, but typical hygiene practices may not be enough to eliminate a vomit-like smell.

While a gentle, fragrance-free soap can help reduce odor, many members of myHSteam have had better luck using antibacterial, antimicrobial, or antiseptic soaps. One member shared, “I tried an antiseptic soap, and it helped with my body odor. My wounds were open and draining.”

Be sure to clean the areas that smell regularly and pat them dry afterward. You should also wear clean clothes and wash them often, as bacteria-filled pus from abscesses can cling to your clothes.

Absorbent Pads or Dressings

Placing absorbent pads or dressings on affected areas can help reduce moisture and odor in affected areas. If you don’t have wound pads, you can try one of the strategies suggested by members of myHSteam for managing discharge with HS:

• “If you have any drainage under your armpit, put a pad under there to absorb it. I stopped buying the expensive wound pads and use cheap period pads instead. They work just as well.”
• “I would make a homemade bandage with a paper towel and some Vaseline. Then you won’t smell it.”
• “I tried stuffing toilet tissue, but it felt like sandpaper on my irritated skin … I switched to T-shirt material and feel much better.”

If you use absorbent pads or dressings in sweaty areas, change them regularly to prevent irritation.

Clinical-Strength Antiperspirant

Clinical-strength antiperspirants containing aluminum chloride can help control sweat and strong odors. The best time to use antiperspirant is right before bed, when sweat glands are less active.

Avoid using deodorant or antiperspirant on broken skin or active HS lesions. Using antiperspirant on broken skin can cause more irritation and increase the risk of developing an allergy to the ingredients of the deodorant or antiperspirant

Medical Treatments

Some medical treatments for HS can help eliminate a vomit-like odor. Topical antiseptics can kill bacteria on your skin’s surface. Always consult your doctor before using any new topical products on skin affected by HS.

Your healthcare provider might prescribe oral antibiotics or topical antibiotics to control infections. Antibiotics kill bacteria, which can reduce odor. Even if your symptoms improve, you must complete the full course of antibiotics as prescribed.

Lifestyle Changes

Your dermatologist can work with you to identify foods or lifestyle factors that trigger HS flare-ups or affect body odor. Possible triggers include:

• Tight clothing
• Synthetic fabrics
• Smoking
• Stress
• Foods that raise blood sugar

By identifying and avoiding these triggers, you may reduce unpleasant odors. Maintaining a lower body weight can also help, as a higher body weight can cause friction between skin folds, which can worsen HS symptoms.

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

Does your skin have an unusual odor? Have you found ways to manage it? Share your experience in the comments below or start a conversation by posting on your Activities page.