When it comes to chronic skin conditions, few things can be more maddening than finding something to wear.
For people with hidradenitis suppurativa (HS), a chronic inflammatory skin condition characterized by recurrent, painful nodules, abscesses, sinus tracts, and scarring, this concern can reach an entirely different level.
What clothes will hide the unsightly marks? What clothes will not worsen the pain and discomfort? What accessories or other items can increase confidence and offer support?
Is it even possible to find something appropriate to wear?
Commonly affecting areas such as the underarms, groin, thighs, and buttocks, HS particularly targets the hair follicles. As a result, it can block the follicles, cause rupturing, and contribute to intense inflammation, often more severe and systemic than that found in typical acne.
Although the prevalence of HS, or acne inversa, varies across estimates, some global figures suggest that around 0.4–1 percent of the population is affected, with women often two to three times more affected than men.
So what can be done?
If you’re looking for clothing that is both appropriate and comfortable for your outings, such as church, family events, or special occasions, you do have options.
RELATED: HS in the Heat: Managing Flare-Ups During Summer Sweat Season
One of the main culprits of problems with HS is friction.
Friction from tight clothing can worsen HS by promoting what is called epidermal hyperplasia – the thickening of the outer skin layer – as well as occlusion, or blocking, and inflammation. Why does this happen? It happens because, when combined, heat, moisture, and sweat retention can all make an affected area even worse.
In fact, many patients cite tight waistbands, seams, bras, underwear, and sleeves as direct triggers of this issue.
The issue is compounded even more when considering societal expectations.
Therein lies the daily dilemma. For instance, while most people opt to wear modest, polished “church clothes,” including dresses, suits, collared shirts, and slacks, these often make the pain and flares even greater.
During these flares, lesions in the groin or underarms can make sitting through a service or standing for photos absolutely agonizing. Then you have the issue of drainage, which can stain light fabrics, adding embarrassment to the unfortunate equation.
Thus, it’s not surprising that various quality-of-life (QoL) studies consistently show that HS may severely impact daily functioning, socialization, and emotional well-being. In most cases, the pain, odor, and dressing hurdles are the main predictors of these QoL impacts.
Thankfully, addressing these issues, individually and collectively, is possible with a consistent approach.
Firstly, prioritize loose, breathable fabrics and cuts.
Your primary goal should be to find loose-fitting garments that allow airflow, which can help reduce friction and prevent painful flares. In many cases, natural fibers such as 100% cotton, bamboo, or linen are ideal. They’re soft, absorbent, and less likely to trap moisture than synthetics such as polyester and nylon.
Simply by avoiding clothing with tight elastic, rough seams, or tags, you’re already making a measurable difference in how your body will feel.
One option is a flowy maxi dress or an A-line skirt made from cotton or bamboo. These are a good option because they skim – but don’t cling to – the body. If you pair these with soft, wireless bralettes or camisoles instead of underwire bras, your comfort can increase even more.
Many females with HS elect to wear loose cardigans and blazers over breathable tops.
By doing this, you allow for that much-desired modesty, but without all the constriction.
Go for black or dark colors over lighter shades to better hide any drainage.
As for men? If you’re heading to a church service or a similar environment, loose button-down shirts of Oxford cloth or cotton are a great first choice. You can style it untucked or with roomy pants, too.
As a rule of thumb, many men go with boxers over briefs, and when it comes to those roomy pants, soft chinos or dress pants with elastic or drawstring waists are ideal. If not possible, look for looser-fitting styles.
Depending on the formality of the event, cotton polos may just be the winning choice.
RELATED: Stay Confident and Fresh: Top 5 Tips for HS Management
Sometimes we can take all the precautions and wear all the seemingly right clothes, yet still suffer a flare-up.
During active flares, comfort must take precedence, but you can still achieve appropriateness.
One of the first things to do is layer strategically. A soft cotton tank or long underwear/biker shorts can help, especially under dresses, to protect the thighs and reduce uncomfortable rubbing.
It’s also important to have spare clothing. Carry or keep extras in a bag for quick changes during drainage. If you’re constantly worried that it could happen at the worst time, put your mind at ease. Some pre-event prep, like gentle cleansing, warm compresses, and prescribed topicals or pain management, is all vital.
Finally, don’t forget your footwear and accessories. Comfortable, breathable shoes are best, as always, and it’s also a good idea to minimize belts and tight jewelry, since you can imagine how they can bother the skin.
Be realistic with yourself. While it’s true that church and family events often emphasize respect and tradition, a little mismatch between what’s appropriate and what’s comfortable is expected.
But that doesn’t mean you can’t make it work overall. The good news is, you still have many options. From modest yet loose Kimono dresses with sleeves to tailored clothes, seasonal lightweight cotton, and smart-casual blazers worn with T-shirts underneath, versatility is key.
Not to mention, many patients find that once flares are better managed medically, the clothing options expand. Weight management and smoking cessation are also useful and are linked to reduced symptom severity.
But let’s pause for a second. If we zoom out and look at this from a broader perspective, it’s clear: HS isn’t just about skin.
Problematic flares also disrupt intimacy, work, sleep, and social life. Dressing challenges can worsen this, causing you to avoid or constantly worry about events that otherwise would be fine. However, by consulting a dermatologist for personalized plans and through clothing tweaks and adjustments, you can reclaim your confidence – and feel better in your skin!
Don’t fall for the false dichotomy. You don’t have to choose between looking respectful and avoiding pain. With intentional choices, from loose silhouettes to breathable natural fabrics and strategic layering, positive change is possible.
Focus on what your body needs that day, and give it your earnest effort. You may just be surprised by how much better you look and feel with time…
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