To preface, there will be some personal detail in this thread that is unavoidable. I apologize if any of this creates discomfort, but I hope that some of my experiences may help others.
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It's been a few years now since I've been diagnosed with Hidradenitis Suppurativa. It is an autoimmune condition that effects the skin and acts like polycystic acne. While I've only been diagnosed in the last few years, it's something I've lived with since around puberty and have learned to deal with...mostly. It's hereditary and not contagious.
(NCBI is one of my favorite references)
Hidradenitis Suppurativa, HS to most medical professionals as it's a mouthful, usually onsets around puberty and often goes undiagnosed as that is an age of pimples and acne anyways.
Over the course of the last few years, I've been seen by dermatologists in Nova Scotia, Ontario and British Columbia and the general consensus at this time is that I can more or less have a lifetime prescription of Doxycycline and Clindamycin but to otherwise keep doing what I've been doing to maintain my skin, so I feel safe in saying that this is dermatologist approved advice on handling HS.
Often people who have it just assume that HS symptoms are a fact of life and never get diagnosed.
I had had issues with folliculitis, ingrown hairs, razor burn etc for quite a while, but I never related the issues on my face to other cysts/nodes on other places on my body. I got reoccurring acne on the backs of my triceps, upper back, hips where my belt rides, and we'll go with other 'creased' places as well. I even had one that was 1 cm x 1 cm x 5 cm under my right armpit one time. I get them on my face, in my scalp etc. Some of the worst were nodes on the inside of my upper eyelid.
My most recent excision was on my right jawline, under where covid masks rest. I was lucky on this surgery as the student doctor on rotation was practicing to be a plastic surgeon and did some fancy stitch so you can barely see the scar. (And under my current beard, you can't tell anyways...). Most of my excisions though were in the crease between my leg/lower buttock. Again, I never related these things to the issues on my face. HS nodes range from tiny, insignificant nothings, to golfball sized subdermal cysts.
Somehow, I never went to a dermatologist in the earlier years. Just go, get things cut out, wait for pathology to come back negative and go on my way. It took a while before I decided I needed to see a dermatologist, and starting asking my doctors for referrals. It took quite a while to get into dermatology for me, but after I did it made everything make so much more sense to me.
It really was a relief to know that it wasn't just me, like technique, products etc. I'll be the first to admit, I really knew nothing about shaving or skin care or anything like that before, but just a little attention to detail has gone a HUGE way for the health of my skin.
The Care of Hidradenitis Suppurativa is so literally just common sense with a touch of diligence.
The biggest key factor, and you see it reported many times on this forum, is proper exfoliation. I 'thought' I exfoliated before, and for those of you who already enjoy a stiff bristled bath brush, you'll know exactly what I mean. A good stiff bristled brush with a handle and ideally a detachable head are your very best friend when you have HS. No amount of soap can do what a brush does. If I was to recommend only one thing for total skincare? It would be a good scrub brush.
Another non-medical factor I would recommend is proper moisturizer. In my experience, cheap/greasy moisturizers only cause more outbreaks and are not worth it. Better no moisturizer than a cheap one, not that I recommend not using the stuff.
Pillowcases and bedsheets are often overlooked. After not properly exfoliating, dirty bedding has been the biggest cause of outbreaks for me. If I don't regularly wash my bedding, I get nodes in my hair and on my shoulders.
These are the external factors that have effected me the most. Obviously excessive sweat and dirt that aren't washed off in a timely manner will almost always cause me new nodes.
As HS is autoimmune, nodes do not go away without removal or medication, so I have had to learn to get rid of the smaller ones myself while avoiding scarring as much as possible.
My only advice here is where possible, use a tool, not your fingers/fingernails. If they don't go easily...wait.
OTC topical antibiotics and bandages are strongly recommended.
After this stage, you get into medical intervention. Antibiotics and Surgeries. Your GP or dermatologist will have more info here.
Since I've learned more about wet shaving, had years of practice now and learned about my diagnosis; I've had next to no issues with shaving and the nodes I get have been greatly reduced. I've had great luck with a straight razor and not getting any further outbreaks on my face.
I strongly recommend anyone who has had persistent issues with their skin to visit a dermatologist. I'm certainly not saying that everyone with skin issues has HS in the slightest, but statistically more people have undiagnosed HS than those that have a diagnosis. The diagnostic process is fairly simple and at least for myself, painless.
I don't feel bad about my skin condition, and really, at the end of the day it's a legit medical excuse to use good quality skin care and shaving products so at least that's a win!
Hopefully this will help to encourage others who may have ongoing skin issues to seek out the help of a dermatologist or at least consult a GP. If not just to confirm you don't have a skin condition. It made a significant difference for me and you may have options you didn't before with a proper diagnosis.
---
It's been a few years now since I've been diagnosed with Hidradenitis Suppurativa. It is an autoimmune condition that effects the skin and acts like polycystic acne. While I've only been diagnosed in the last few years, it's something I've lived with since around puberty and have learned to deal with...mostly. It's hereditary and not contagious.
(NCBI is one of my favorite references)
Hidradenitis Suppurativa, HS to most medical professionals as it's a mouthful, usually onsets around puberty and often goes undiagnosed as that is an age of pimples and acne anyways.
Over the course of the last few years, I've been seen by dermatologists in Nova Scotia, Ontario and British Columbia and the general consensus at this time is that I can more or less have a lifetime prescription of Doxycycline and Clindamycin but to otherwise keep doing what I've been doing to maintain my skin, so I feel safe in saying that this is dermatologist approved advice on handling HS.
Often people who have it just assume that HS symptoms are a fact of life and never get diagnosed.
I had had issues with folliculitis, ingrown hairs, razor burn etc for quite a while, but I never related the issues on my face to other cysts/nodes on other places on my body. I got reoccurring acne on the backs of my triceps, upper back, hips where my belt rides, and we'll go with other 'creased' places as well. I even had one that was 1 cm x 1 cm x 5 cm under my right armpit one time. I get them on my face, in my scalp etc. Some of the worst were nodes on the inside of my upper eyelid.
My most recent excision was on my right jawline, under where covid masks rest. I was lucky on this surgery as the student doctor on rotation was practicing to be a plastic surgeon and did some fancy stitch so you can barely see the scar. (And under my current beard, you can't tell anyways...). Most of my excisions though were in the crease between my leg/lower buttock. Again, I never related these things to the issues on my face. HS nodes range from tiny, insignificant nothings, to golfball sized subdermal cysts.
Somehow, I never went to a dermatologist in the earlier years. Just go, get things cut out, wait for pathology to come back negative and go on my way. It took a while before I decided I needed to see a dermatologist, and starting asking my doctors for referrals. It took quite a while to get into dermatology for me, but after I did it made everything make so much more sense to me.
It really was a relief to know that it wasn't just me, like technique, products etc. I'll be the first to admit, I really knew nothing about shaving or skin care or anything like that before, but just a little attention to detail has gone a HUGE way for the health of my skin.
The Care of Hidradenitis Suppurativa is so literally just common sense with a touch of diligence.
The biggest key factor, and you see it reported many times on this forum, is proper exfoliation. I 'thought' I exfoliated before, and for those of you who already enjoy a stiff bristled bath brush, you'll know exactly what I mean. A good stiff bristled brush with a handle and ideally a detachable head are your very best friend when you have HS. No amount of soap can do what a brush does. If I was to recommend only one thing for total skincare? It would be a good scrub brush.
Another non-medical factor I would recommend is proper moisturizer. In my experience, cheap/greasy moisturizers only cause more outbreaks and are not worth it. Better no moisturizer than a cheap one, not that I recommend not using the stuff.
Pillowcases and bedsheets are often overlooked. After not properly exfoliating, dirty bedding has been the biggest cause of outbreaks for me. If I don't regularly wash my bedding, I get nodes in my hair and on my shoulders.
These are the external factors that have effected me the most. Obviously excessive sweat and dirt that aren't washed off in a timely manner will almost always cause me new nodes.
As HS is autoimmune, nodes do not go away without removal or medication, so I have had to learn to get rid of the smaller ones myself while avoiding scarring as much as possible.
My only advice here is where possible, use a tool, not your fingers/fingernails. If they don't go easily...wait.
OTC topical antibiotics and bandages are strongly recommended.
After this stage, you get into medical intervention. Antibiotics and Surgeries. Your GP or dermatologist will have more info here.
Since I've learned more about wet shaving, had years of practice now and learned about my diagnosis; I've had next to no issues with shaving and the nodes I get have been greatly reduced. I've had great luck with a straight razor and not getting any further outbreaks on my face.
I strongly recommend anyone who has had persistent issues with their skin to visit a dermatologist. I'm certainly not saying that everyone with skin issues has HS in the slightest, but statistically more people have undiagnosed HS than those that have a diagnosis. The diagnostic process is fairly simple and at least for myself, painless.
I don't feel bad about my skin condition, and really, at the end of the day it's a legit medical excuse to use good quality skin care and shaving products so at least that's a win!
Hopefully this will help to encourage others who may have ongoing skin issues to seek out the help of a dermatologist or at least consult a GP. If not just to confirm you don't have a skin condition. It made a significant difference for me and you may have options you didn't before with a proper diagnosis.
