Living with hidradenitis suppurativa (HS) can feel like navigating a maze of potential triggers that can lead to flare-ups. While triggers don’t cause HS to develop, understanding and managing them can help control symptoms and improve your quality of life.

Members of myHSteam often discuss what triggers their symptoms. One member shared, “I think my main trigger is stress, but that’s hard to avoid when you deal with HS.” Another said, “So far, my biggest triggers are potatoes and tomatoes. I’m pretty sure sugar plays a part as well.”

Research shows that HS develops due to a mix of genetics, environment, and lifestyle factors. By identifying and addressing triggers, many people find they can better manage their condition. Let’s explore some common HS triggers.

1. Genetic Triggers

HS develops in people who are genetically predisposed to it. Specific genetic variants are linked to HS, and about 30 percent to 40 percent of people with HS have a family history of the condition. This suggests a strong genetic connection.

2. Physical Factors

Physical factors can often trigger HS flares, but many can be managed with proper care. Some common physical triggers include:

• Friction from tight or rough clothing
• Excessive sweating, especially in skin folds
• Shaving or other hair removal methods
• Irritation from products like lotions, deodorants, and creams, especially those with artificial fragrances

“Deodorant is a trigger for me,” one myHSteam member wrote. “I use natural deodorant — anything else causes a flare-up.”

Physical factors — thickening skin, friction due to shaving, or skin rubbing together — can block hair follicles, which can trigger an HS flare-up. That’s because a blocked hair follicle signals to your body that the follicle is damaged, which triggers your immune system and causes inflammation. This inflammation can lead to HS symptoms like painful lesions and abscesses.

Here are some ways to avoid physical triggers:

• Wear loose-fitting, breathable clothing.
• Use antimicrobial soaps and washes.
• Choose antiperspirants and other topical products without fragrances or dyes.
• Don’t scrub your skin.
• Consider alternative hair removal methods, like laser hair removal, instead of shaving or waxing affected areas.
• Try to avoid overheating and sweating excessively.

3. Diet

For some people, diet can play a role in triggering HS symptoms. Certain foods may cause an inflammatory response in the body, which could worsen HS symptoms.

Common food triggers include:

• Dairy products
• Carbohydrates (pasta and bread)
• Refined sugars
• Brewer’s yeast (found in some breads, beer, and fermented foods)
• High-fat foods
• Processed foods

One study found that nearly 31 percent of participants saw improvement after cutting out alcohol, dairy, gluten, tomatoes, and refined sugars. However, others in the same study reported worse symptoms after changing their diet.

As one myHSteam member said, “I love cheese, but it does not love me. Cheese triggers the worst HS outbreaks.”

While there is currently no specific diet recommended for people with HS, some research suggests that the Mediterranean diet, which focuses on consuming vegetables, fruits, healthy oils, nuts, and fish, may help reduce chronic inflammation. You can also try an elimination diet, where you remove certain foods from your diet to see how your body responds.

Dietary triggers can vary greatly from person to person. Keeping a daily food diary may help you identify potential triggers for your HS symptoms. One myHSteam member suggested, “Read and study your body. Make notes of the times and dates of flare-ups. Write down the foods you have eaten before the flare-up, too.”

4. Smoking

Smoking is one of the most common HS triggers. Cigarette smoke contains thousands of chemicals that affect skin cells and the immune system. Tobacco smoke and nicotine increase inflammation, which can worsen HS symptoms.

People with HS who smoke often have more areas of their body affected by the condition than those who don’t smoke or have quit. Smoking can also make HS treatments less effective.

One myHSteam member said, “I think this flare-up was so bad because I had almost quit smoking, and then I started smoking again.”

Another shared, “I am in remission, and I mainly attribute it to stopping smoking. I’ve been told for years that stopping smoking would help my HS, but NEVER was I told that it could be so effective as to eradicate it!”

Quitting smoking may reduce the risk of HS developing or symptoms worsening.

5. Weight Management

Having a higher body weight is thought to trigger HS flare-ups because people with higher body weights often have more areas of skin that rub together. Rubbing can cause friction, and friction may trigger an HS flare. A higher body weight, like smoking, may also cause other changes to the body that could affect HS, such as low levels of chronic inflammation around the hair follicles and skin thickening.

Research shows a strong link between obesity and HS symptoms. Some people with obesity and HS report that their weight loss helped improve their HS symptoms.

“I lost 85 pounds on my own about 10 years ago,” one myHSteam member wrote. “I did see a difference in my flare-ups when I lost the weight.”

However, it’s important to remember that not everyone with HS has a high body weight, and not everyone who loses weight sees an improvement in their symptoms.

6. Vitamin D3

Low levels of vitamin D3 may worsen HS symptoms. Vitamin D3 is found in foods like tuna, salmon, trout, and fortified foods. Your body also produces vitamin D3 when exposed to sunlight.

A 2022 study found that people with HS are more likely to have low vitamin D levels. On average, their vitamin D3 levels were less than half the recommended amount.

According to the National Health and Nutrition Examination Survey (NHANES), about 42 percent of U.S. adults have a vitamin D3 deficiency (levels below 20 nanograms per milliliter). This deficiency is more common in certain groups, such as Hispanic and African American populations.

If you’re concerned about your vitamin D3 levels, talk to your healthcare provider. They may recommend supplements or regular monitoring to help manage your HS symptoms.

7. Medications

Some medications that help activate the immune system may trigger HS symptoms, though more research is needed. For example, anti-PD-1 therapies (used to treat certain cancers) may trigger HS symptoms. One study found that certain immunosuppressants (drugs that suppress the immune system) can be linked to HS.

If you’re concerned about how your current medications might affect your HS symptoms, talk to your doctor. Never start or stop any medication without consulting your healthcare provider.

Working With Your Healthcare Team

Everyone’s body is different. While identifying your triggers can feel overwhelming, you don’t have to do it alone. Work closely with your dermatologist or healthcare provider to create a personalized plan for identifying and managing your HS triggers. They can help you track potential triggers, recommend specific lifestyle changes, and ensure you’re following the most effective treatment plan for your situation.

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.

Have you discovered your HS triggers? Do you have any advice on how to avoid common triggers? Share your experience in the comments below, or start a conversation by posting on your Activities page.