Deodorant/antiperspirant use and hair removal practices for hidradenitis suppurativa: recommendations from a single-center survey : International Journal of Women's Dermatology

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Therapeutic Pearls

Deodorant/antiperspirant use and hair removal practices for hidradenitis suppurativa: recommendations from a single-center survey

Cutler, Brett MDa,b; Hagstrom, Erika MDa; Greiling, Teri M. MD, PhDa,*

Author Information
International Journal of Women’s Dermatology 9(1):p e028, March 2023. | DOI: 10.1097/JW9.0000000000000028
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Clinical problem

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder that frequently affects the axillae. Axillae are also targeted for societal hygiene practices: namely, the use of deodorants and antiperspirants and techniques for hair removal. HS is associated with an increased risk of hyperhidrosis and female hirsutism due to polycystic ovarian disease, further increasing the impact of these practices on quality of life.1,2 Patients with HS are often unsure how to appropriately target physiological body odor and hair removal without worsening their HS. A 1982 case-control study concluded simply that deodorant, shaving, and chemical depilatories are not causative of HS,3 but little guidance beyond this is available for patients or their providers.

Therapeutic solution

We conducted a single-center survey of 87 individuals, in which participants living with axillary HS consistently identified spray deodorant and laser hair removal as the most beneficial underarm hygiene practices to avoid exacerbation of HS. Conversely, solid stick deodorant and shaving with a razor were associated with increased HS severity. Over half of those surveyed reported that all deodorants/antiperspirants worsened their HS; however, topical antimicrobials (chlorhexidine or benzoyl peroxide) were beneficial for the control of body odor related to perspiration. These group experiences can be used to guide providers who advise patients about HS.

The study conclusions were drawn from a 22-question survey about HS hygiene practices. The authors attempted to call all adult patients with a diagnosis of HS seen at the Oregon Health & Science University (OHSU) dermatology clinic between October 2020 and March 2021 (n = 170). Eighty-seven patients answered their phone, of which 68 (78.2%) assented to complete the survey (Table 1). Fifty (74.6%) patients were women, reflecting the female predominance of HS.4

Table 1 - Characteristics of survey respondents
Characteristic No. (%)
Age, y 6 (9.0)
 18–24 22 (32.8)
 25–34 23 (34.3)
 35–44 12 (17.9)
 45–54 0 (0)
 55–64 4 (6.0)
 65+
Sex 17 (25.4)
 Male 50 (74.6)
 Female
Race 48 (64.0)
 White 10 (13.3)
 Black/African American 5 (6.7)
 Hispanic/Latino 3 (4.0)
 Native American 2 (2.7)
 South Asian 3 (4.0)
 East Asian 1 (1.3)
 Middle Eastern 2 (2.7)
 Pacific Islander 1 (1.3)
 Other
Mean Hurley Score 1.8
Mean BMI 37.2
Smoker
 Yes, current 15 (22.4)
 Yes, past 23 (34.3)
 No 29 (43.3)
BMI, body mass index.

Of the 59 participants who used deodorant/antiperspirant on their axillary HS, 31 (52.5%) reported that all products worsened their HS. Solid stick deodorant, used by 84.7% of participants, received the most ratings of “very harmful” to users’ HS (24.0%) (Fig. 1A). Spray, used by 49.1%, received the most “helpful” ratings (31.0%). Notably, the majority of participants (84.7%) had tried solid stick deodorant, whereas only 49.2% had tried spray—this likely represents a North American bias, since spray deodorants tend to be favored in the European market.5 Topical antimicrobials recommended for HS were perceived to have a positive impact on physiological body odor, with 29 of 45 (64.4%) and 18 of 27 (66.7%) of participants who used chlorhexidine solution and benzoyl peroxide wash respectively reporting these products were helpful for controlling body odor.

F1
Figure 1.:
Survey respondents’ report of how types of deodorant/antiperspirant (A) or hair removal methods (B) affected their hidradenitis suppurativa severity.

When questioned about hair removal, 45 of 50 (90%) female and 11 of 17 (64.7%) male participants had attempted some form of depilation. Eighteen of 22 (85.7%) participants who tried laser hair removal indicated it was helpful for their HS (Fig. 1B). A higher proportion of women (38.0%) than men (11.8%) had tried this method of hair removal, and it appeared to be helpful for both genders. In contrast, shaving was rated as harmful for HS in 36/48 (75%) participants.

Conflicts of interest

None.

Funding

None.

Study approval

N/A.

Author contributions

All authors participated in the study design, data acquisition, analysis and interpretation of the data, drafting and revising the manuscript, and final approval.

References

1. Hua VJ, Kuo KY, Cho HG, Sarin KY. Hyperhidrosis affects quality of life in hidradenitis suppurative: a prospective analysis. J Am Acad Dermatol 2020;82:753–754. doi: 10.1016/j.jaad.2019.08.046.
2. Garg A, Neuren E, Strunk A. Hidradenitis suppurative is associated with polycystic ovary syndrome: a population-based analysis in the United States. J Invest Dermatol 2018;138:1288–1292. doi: 10.1016/j.jid.2018.01.009.
3. Morgan WP, Leicester G. The role of depilation and deodorants in hidradenitis suppurativa. Arch Dermatol 1982;118:101–102. doi: 10.1001/archderm.1982.01650140033014.
4. Garg A, Lavian J, Lin G, Strunk A, Alloo A. Incidence of hidradenitis suppurativa in the United States: a sex- and age-adjusted population analysis. J Am Acad Dermatol 2017;77:118–122. doi: 10.1016/j.jaad.2017.02.005.
5. Matthews I. (2021, July 1). A Look Into the Antiperspirant, Deodorant Marketplace. Happi. Available at: https://www.happi.com/issues/2021-07-01/view_eurotrends/a-look-into-the-antiperspirant-deodorant-marketplace/. Accessed December 21, 2022.
Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of Women’s Dermatologic Society.