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Daily life with HS

HS Clothing & Friction Guide

Most advice stops at "wear loose clothing". This guide goes further: why friction matters, how it differs by body area, which clothing characteristics change it — and what to ask your clinician.

Choose a body area

Friction does not work the same way everywhere. Skin rubbing on skin in a fold is a different problem from fabric moving across skin — so the useful clothing considerations differ too. Select an area to open it, or use the list below the diagram.

1 1 2 3 4 5 5

Front view

6 6 5 5

Back view

Select a numbered marker or a heading in the list to open that body area. Schematic outline of a human body, front and back view, with numbered markers on the underarms, under the breasts, the abdomen, the groin, the inner thighs and the buttocks. Each marker links to the section for that area.
  1. Underarms
  2. Under the breasts
  3. Abdomen & skin folds
  4. Groin
  5. Inner thighs
  6. Buttocks
Underarms (axillae)

Why friction happens here

The armpit is a skin fold that opens and closes with almost every arm movement. Arm and torso rub against each other, on top of the sleeve moving across the skin.

It is also warm and moist: sweat stays in the fold, and softened skin is mechanically more fragile. Friction, heat and moisture meet here — exactly the combination the literature describes as mechanical stress.

Clothing considerations

  • Sleeve shape and armhole decide how much fabric actually sits in the fold and moves with it — often more than the fabric type itself.
  • Seams, labels and reinforcement patches frequently sit right on the most sensitive spot in the armpit.
  • Materials that move moisture away from the skin, or absorb it, keep the fold drier than fabrics that hold sweat against the skin.
  • A thin, smooth layer under outer clothing shifts the rubbing from skin onto fabric — many people use this principle without naming it.
  • If dressings are worn, clothing co-determines whether the dressing stays in place or shifts.

Questions to discuss with a healthcare professional

  • Could friction in the armpit be contributing to my symptoms?
  • Should I change shaving or hair removal in this area while the skin is irritated?
  • What should I keep in mind about deodorant or skin care in an inflamed area?
  • How can I keep a dressing in place in the armpit without taping onto sore skin?
Under the breasts (inframammary fold)

Why friction happens here

Under the breasts, skin rests on skin continuously. Unlike the armpit, the strain here comes less from movement and more from sustained contact, warmth and trapped moisture.

Added to that is pressure from bands, fasteners and shaping elements that run exactly along this line. Pressure plus rubbing in the same place for many hours is a different kind of load from short, vigorous movement.

Clothing considerations

  • How wide a band is and how it spreads the load changes pressure per area — a wider, soft band distributes it, a narrow one concentrates it.
  • Rigid shaping elements (such as underwires) sit, by construction, exactly in the fold.
  • Fit changes with weight, hormonal status, pregnancy and time; a garment that once fitted well may press today.
  • A thin, absorbent layer in the fold separates skin from skin — principle rather than product: what matters is a dry, smooth separating layer.
  • Fasteners and seams at the back or sides can matter as much as the fold itself when those areas are involved.

Questions to discuss with a healthcare professional

  • Could pressure or friction under the breasts be playing a role for me?
  • During a flare, are there reasons to change or temporarily go without supportive garments?
  • How can I keep the fold dry without irritating the skin further?
  • Should this area be specifically examined at my next appointment?
Abdomen and skin folds

Why friction happens here

At the abdomen and in abdominal folds, two things combine: a fold where skin rests on skin, and a waistband running across it. The band often sits exactly where the fold is deepest.

Sitting changes the geometry again — a waistband that feels loose standing up can dig in for hours once you sit down.

Clothing considerations

  • Waistband height decides whether it runs above, on, or below an affected spot. That choice is often more effective than the choice of material.
  • Wide, soft waistbands spread pressure; narrow, strongly elastic ones concentrate it into a line.
  • Carrying the load from the shoulders (braces, bib-style cuts) shifts it away from the abdomen — a principle that is rarely mentioned.
  • Stiff fabrics kink inside a fold and create edges; softly draping materials lie flatter.
  • Check while sitting, not only while standing: daily life often happens seated.

Questions to discuss with a healthcare professional

  • Could waistband pressure be playing a role at my affected sites?
  • Is there any sign that friction in an abdominal fold contributes to my flares?
  • What can I do if a fold keeps becoming moist and sore despite care?
  • Should we talk about how weight, skin and symptoms interact for me — without that becoming pressure?
Groin and genital area

Why friction happens here

The groin crease moves with every step, every time you sit down and stand up. At the same time, leg openings, elastic edges or seams almost always run through it — often right along the crease line.

The area is warm, often moist and hard to ventilate. Because it is intimate, it is easily left out of conversations, even though it is one of the most commonly affected regions.

Clothing considerations

  • The cut of the leg opening decides whether an edge sits in the crease or above/below it.
  • Seamless or flat-finished transitions avoid hard edges on a line that is constantly moving.
  • Longer leg shapes can reduce skin-on-skin contact at the inner thigh, but add fabric and warmth — weighing the two against each other is normal.
  • Changing more often on sweaty days often does more than searching for the "right" material.
  • Washing new textiles before first wear removes finishing residues — general advice for sensitive skin, not HS-specific evidence.

Questions to discuss with a healthcare professional

  • Could the edge of a garment be sitting exactly on my affected area?
  • How should I clean and dry this area during a flare?
  • What should I know about hair removal in the groin while lesions are present?
  • What does this mean for exercise, cycling or long periods of sitting in my case?
Inner thighs

Why friction happens here

On the inner thighs, skin usually rubs directly on skin rather than fabric on skin. Walking repeats that contact thousands of times; heat and sweat amplify the effect.

This is the area where many people notice the link between activity, weather and symptoms most clearly.

Clothing considerations

  • A smooth intermediate layer changes the nature of the contact: skin no longer rubs on skin. Its length and how it stays put decide whether it helps or chafes itself.
  • A layer that rides up over the day can create a new line of friction at its edge.
  • For longer exertion, how long something is worn without changing matters more than what is worn.
  • Contact at this site changes fundamentally between winter and summer clothing — your strategy is allowed to change with the season.
  • Skin-barrier preparations to reduce skin-on-skin friction exist; whether they make sense over open or inflamed skin is a clinical question, not general advice.

Questions to discuss with a healthcare professional

  • Is friction on my inner thighs pronounced enough to be contributing to symptoms?
  • Would a skin-barrier preparation be reasonable in my case — and where should it definitely not be used?
  • How can I stay active in sport without adding strain to this area?
  • When should chafed skin here be looked at by a clinician?
Buttocks and gluteal cleft

Why friction happens here

At the buttocks, pressure from your own body weight is added to friction. Long periods of sitting load the same spot for hours — with little air exchange and a lot of warmth.

The gluteal cleft itself is a deep fold that holds moisture. Seams running through it are pressed further into the skin while sitting.

Clothing considerations

  • Where the back centre seam runs decides whether a seam sits in the gluteal cleft.
  • Narrow shapes that run through the cleft concentrate friction exactly there; wider shapes spread it.
  • Seat surface and sitting time interact with clothing here — standing up or shifting regularly is part of relieving the load.
  • Stiff, thick fabrics form folds while sitting that press at single points.
  • With draining lesions, absorbency and fit co-determine how secure a long day feels.

Questions to discuss with a healthcare professional

  • Could long periods of sitting and pressure be part of my symptoms at the buttocks?
  • How do I tell friction and pressure apart from something that needs clinical assessment?
  • What should I keep in mind about sitting after surgery in this area?
  • Would adjusting my workplace setup be a reasonable topic to raise?

Clothing characteristics, explained neutrally

Clothing is easier to think about as a set of characteristics than as a list of garments. Each characteristic below explains what it is, why it may matter for skin under friction, and what it costs you elsewhere — because none of them is universally better.

Fabric characteristics

Breathability
What it means
How easily air and water vapour pass through a textile. It depends on fibre, density and weave — not on the fibre name alone.
Why it may matter
Heat and moisture collect in skin folds. Softened skin is mechanically more fragile, so the same amount of rubbing has a stronger effect.
The trade-off
A very airy weave can be thin and offer little glide; a dense, smooth weave protects against rubbing but tends to trap warmth.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Moisture handling
What it means
Some textiles absorb moisture and hold it; others move it to the surface, where it evaporates.
Why it may matter
What matters is not "absorbing" or "wicking" as such, but how long moisture actually stays against the skin.
The trade-off
Absorbent fabrics feel dry at first but stay damp for a long time; wicking fabrics dry faster but some people find them less pleasant.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Surface and softness
What it means
How smooth or rough a textile feels on the skin, and whether it glides rather than catches.
Why it may matter
A smooth surface reduces the force acting on the skin surface with every movement.
The trade-off
Softness says nothing about moisture behaviour. A very soft fabric can still hold heat and wetness against the skin.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Seams, edges and labels
What it means
Where seams run, how flat they are finished, and whether labels or applied parts sit against the skin.
Why it may matter
A seam can concentrate pressure into a narrow line. If that line crosses an affected site, seam routing often matters more than the fibre.
The trade-off
Seamless constructions often need more stretch — and therefore more contact with the body. Less seam can mean more pressure.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Fit and construction

Compression and closeness
What it means
How firmly a garment presses against the body, and how evenly that pressure is distributed.
Why it may matter
Sustained pressure on an inflamed site is a load in its own right — in addition to friction, not instead of it.
The trade-off
Close-fitting layers can reduce skin-on-skin friction while increasing pressure. Weighing the two is part of the decision.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Elastic bands and cuffs
What it means
Narrow, strongly elastic bands at the waist, leg opening or sleeve concentrate tension into a line.
Why it may matter
Those lines often run exactly through the regions HS affects — groin, waist, armpit.
The trade-off
With no hold at all, clothing shifts and creates new friction elsewhere. This is about distribution, not doing without.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Rigid supporting elements
What it means
Underwires, boning, fasteners and stiff edges provide shape — and do not yield under load.
Why it may matter
By construction they often sit in exactly the folds where HS lesions occur, and stay there for hours.
The trade-off
Support serves a purpose. The point is not to avoid it on principle, but to check exactly where it rests.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Loose or close-fitting?
What it means
"Wear it loose" is the most common advice — and too imprecise where skin touches skin. Loose fabric can travel across the skin and chafe in its own right.
Why it may matter
The more useful question is: does skin rub on skin here, or fabric on skin? Skin-on-skin calls for a smooth separating layer; fabric-on-skin calls for less tension and less fabric movement.
The trade-off
This is why there is no generally "correct" looseness. The same person may need different solutions at different body sites.

Limited evidence Rests mainly on case series, preliminary studies, or expert consensus.

Situations and activities

The same body area behaves differently on a desk day, on a run and on a long flight. These sections describe what changes — and what stays the same.

Office and desk work

Long periods of sitting load the same spot for hours, while dress codes can limit your room to manoeuvre.

  • The layer directly against the skin is usually the part you can decide freely about — even when outer clothing is prescribed.
  • How a waistband sits while seated says more than how it sits while standing.
  • Standing up regularly interrupts sustained pressure; it is no substitute for treatment, but it costs nothing.
  • A spare item in a locker or bag makes a long day more predictable.
  • If dress requirements and symptoms collide regularly, that is a topic for your appointment — and possibly for occupational health advice.
Exercise and movement

Movement matters for general health. With HS, the practical hurdles are usually friction, sweat and the time right after training.

  • In sport, friction repeats very often in a short time — the duration of the load matters especially here.
  • Staying in wet sports clothing after training noticeably extends the damp phase against the skin.
  • Sports differ a lot in which body site they load; switching activity is one option among several.
  • Adjusting intensity during a flare is a legitimate decision, not a setback.
  • If exercise regularly triggers symptoms, that is a reason to raise it — not a reason to drop movement altogether.
Long-distance travel

Travel combines long sitting, few chances to change, shifting temperatures and limited access to washing facilities.

  • Layers you can add or remove without a changing room give you room to react to temperature changes.
  • A change of clothes in hand luggage rather than checked baggage is the difference between a plan and a hope.
  • During long sitting, standing up relieves the same sites that office work loads.
  • Air conditioning and heat alternate quickly; several thin layers are more flexible than one thick one.
  • If you use dressings, plan change times along the legs of the journey.
Heat and sweating

Warmth increases sweat and moisture in skin folds — the factor many people notice most clearly.

  • How long moisture stays against the skin matters more than the amount of sweat itself.
  • On hot days, changing more often often does more than any material decision.
  • Gently drying folds after showering or swimming follows the same logic — without rubbing.
  • Shade, breaks and timing change the load without any change of clothing.
  • Very light colours show wetness more clearly, very dark ones heat up more — both are trade-offs, not rules.
Cold weather and layers

In winter the problem is usually on the inside: several thick layers plus heated rooms lead to sweating underneath.

  • Several thin, removable layers let you react when you enter a warm room.
  • Thick, stiff outer layers push folds into the layers underneath while sitting.
  • The innermost layer decides what happens in the skin fold — the outermost only decides temperature.
  • Dry heated air and frequent hot showers can put extra strain on the skin barrier.
  • Even in winter it can help to change the layer next to the skin after a long day.
Sleep

Sleepwear is worn for seven to nine hours at a stretch — usually longer than any other garment of the day.

  • Body position changes often in sleep; tight cuffs travel and can create new pressure points.
  • Room temperature and bedding often influence sweating more than sleepwear itself.
  • With draining lesions, washable protective layers on the mattress ease night-time worries.
  • Clothing that opens without pulling it over your head makes a night-time dressing change easier.
  • If pain regularly disturbs your sleep, that belongs in your appointment — sleep loss is a problem in its own right.

Questions About Clothing and Skin Friction

Print this checklist and take it to your next appointment. Fill in your situation, tick what you want to raise, and use the questions as prompts — clothing rarely comes up unless you bring it up.

My situation

  • Affected body areas
  • Areas where clothing regularly bothers me
  • Hours per day spent sitting
  • Changes of clothes per day on sweaty days
  • Situations in which it is worst

Topics I want to raise

  • Skin-on-skin friction (e.g. inner thighs, armpit)
  • Pressure from waistbands, bands or supporting elements
  • Seams or edges over affected areas
  • Sweating and moist skin folds
  • Clothing during exercise and movement
  • Dress requirements at work
  • Clothing and dressings together
  • Burden from marks, odour or visibility

Questions for my care team

  • Could friction be contributing to my symptoms?
  • Which practical changes do you recommend for the areas affected in my case?
  • Should I modify exercise clothing during active flares?
  • Would a skin-barrier preparation be reasonable in my case — and where not?
  • How can I keep affected folds dry without irritating the skin?
  • When should chafed skin be assessed by a clinician?
  • Is there any sign that something other than friction is behind this in my case?

My notes

Space for observations, dates, or anything else you want to remember to say.

This checklist collects discussion topics only. It contains no medical advice and does not replace professional assessment.

Scientific research and editorial review

Last editorially reviewed: · Next scheduled review:

Friction and mechanical stress are widely described as aggravating factors in hidradenitis suppurativa, and dermatology guidance consistently recommends reducing them. The evidence behind specific clothing choices, however, comes mainly from expert consensus, clinical reviews and observational studies rather than controlled trials — which is why every principle on this page carries an evidence grade and none is presented as treatment.

That clothing has a real impact on daily life is better documented than any single clothing recommendation: observational and qualitative studies consistently find that people with HS adapt what they wear, including those with milder disease.

This page is source-linked and reviewed at least once a year. If a cited guideline, review or study changes, the page is updated.

How we work: Editorial Policy

Living With Acne Inversa The wider daily-life hub: routines, work, relationships and long-term coping. HS Wound Care & Dressing Guide Drainage, dressing changes and protecting clothes — organised by situation. Symptom Tracker Log friction, sweating and flares over time to see your own patterns. HS, Pregnancy & Family Planning When the body changes, so do folds and fit — the reproductive-health hub covers what else shifts. Prepare for an HS Treatment Conversation Build a question list for your next dermatology appointment. Clothing for Acne Inversa: Friction, Fabrics, and Cut The long-form article behind this guide, with more background detail. Hair removal with HS Shaving, trimming, waxing and laser hair reduction compared, including what avoiding friction over active lesions actually means. Acne Inversa Glossary Look up any unfamiliar term used on this page.

Sources

  1. Loh TY, Hendricks AJ, Hsiao JL, Shi VY. Undergarment and Fabric Selection in the Management of Hidradenitis Suppurativa Dermatology, 2021;237(1):119–124 (published online 2019)
  2. Singh V et al. Hidradenitis suppurativa may impact clothing patterns even in patients with mild disease and symptoms — observational study British Journal of Dermatology, 2022;187(2):250–252
  3. Buttar S et al. Overall Cumulative Burden of Hidradenitis Suppurativa: An In-Depth Qualitative Examination JEADV Clinical Practice, 2026 — qualitative interview study; clothing was among the most frequently reported adaptations
  4. Ingram JR et al. British Association of Dermatologists guidelines for the management of hidradenitis suppurativa (acne inversa) 2018 British Journal of Dermatology, 2019;180(5):1009–1017 — self-management is recommended, while the evidence base for it is explicitly described as limited
  5. American Academy of Dermatology: Hidradenitis suppurativa — self-care Patient information; recommends looser clothing among other measures, because clothing that rubs can irritate the skin
  6. European S2k guideline for hidradenitis suppurativa / acne inversa, part 2: treatment Journal of the European Academy of Dermatology and Venereology, 2025 — situates self-management alongside medical treatment