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Recurring boils and contact sports: training BJJ and wrestling with HS
Training BJJ or wrestling with hidradenitis suppurativa (HS)? Learn how to tell HS from mat infections, protect your skin, and keep training through flares.
Key takeaways
Hidradenitis suppurativa (HS) is a long-term skin condition, not an infection, so you can't pass it to a training partner. Poor hygiene doesn't cause it either.
An HS lump and an infected boil can look alike, so get any new lump checked before you roll. A lab test of the fluid can show whether it's an infection.
Contact a doctor promptly if a lump comes with a fever or red streaks spreading out from it. Boils that keep coming back after treatment are worth a dermatologist visit too.
Heat, sweat, and rubbing on the mat can set off HS flares. Showering soon after training, washing gently, and wearing clean, dry gear can help your skin.
You may be able to stay active during a flare by changing how you train. A dermatologist can help you choose between drilling, other workouts, or rest based on where the flare is.
Plenty of athletes with hidradenitis suppurativa (HS) keep training BJJ, wrestling, and other contact sports, recurring boils and all. HS is a long-term inflammatory skin condition, and you can't give it to the people you roll with.
Lumps that keep returning to the armpits, groin, inner thighs, or buttocks can have more than one cause. HS is one possible reason for boils that keep coming back in those spots. Heat, sweat, and long rounds can make those flares harder to manage, so what helps most is a plan that fits the way you train.
In practice, that means getting new lumps checked and looking after your skin before and after class. It also means deciding with a dermatologist what to do when a flare hits. That last part is much easier to sort out a month before a tournament than the week of it.
Why BJJ, wrestling, and contact sports are hard on HS-prone skin
No one fully knows what causes HS. What dermatologists do know is that heat, sweat, and friction tend to set off flares. A session on the mat puts all three on the folds where HS appears.
Heat, sweat, and pressure add up on the mat
Dermatologists who wrote exercise recommendations for HS for people doing general workouts point to heat, sweat, and friction as common flare triggers. Grappling stacks all three, because you spend an hour in a warm room with someone's weight pressing into you.
Overheating and tight clothing that rubs can play a part too, which matters in a sport where the gear is tight by design. Add a gi collar rubbing the same armpit through every grip fight, or a damp mat between rounds. It's easy to see why the boils keep coming back in the same places.
Where the pressure lands depends on your game, but a few patterns come up often:
Guard work, hip escapes, and pins load the groin and inner thighs.
Underhooks and clinches press into the armpits.
Bottom positions and scrambles grind on the buttocks.
Inner-thigh bumps can also come from plain friction. If you can't tell whether yours are chafing or something else, bring them up at your next dermatology visit.
Where HS usually shows up
HS lumps form where skin touches skin or rubs, which means the armpits, groin, inner thighs, buttocks, and the skin around the anus. HS affects men as well as women, and Tono's guide to recurring groin and buttock lumps explains how it often shows up in men.
HS or a mat infection: what spreads and what doesn't
HS isn't an infection, and NIH's HS overview is clear that it isn't contagious and isn't caused by poor hygiene. That sets it apart from the staph boils, herpes, and ringworm that move through mat rooms. Even so, an HS lump can look a lot like a boil.
Condition | What it is | Spreads to training partners? | What usually happens next |
|---|---|---|---|
HS | Long-term inflammation of the hair follicles | No | Ongoing care with a dermatologist |
Staph or MRSA boil | Bacterial infection of a hair follicle | Yes, through skin contact and shared towels or gear | An exam, and possibly a lab test of the fluid |
Impetigo | Bacterial infection of the top layer of skin | Yes | Treatment and time off the mat |
Herpes gladiatorum | Skin infection from herpes simplex virus type 1 (HSV-1) | Yes, skin to skin | Antiviral treatment and time off the mat |
Ringworm (tinea) | Fungal skin infection | Yes | Antifungal treatment and time off the mat |
Boils, HS lumps, and other skin infections are hard to tell apart on your own. Telling them apart takes an exam, and sometimes a lab test. For more detail on boils, MRSA, and cellulitis, read how HS differs from staph.
Why a new lump gets checked before you roll
Skin infections cluster in contact sports. The CDC guidance for athletes notes that infections, including MRSA, are most reported in wrestling, football, and rugby, with cases in martial arts too.
MRSA is also hard to tell from other bacteria without lab tests. Looks alone won't tell you whether a lump is an HS flare or a MRSA boil. That's why a first-time or changing lump deserves an exam before you get back on the mat, even if you've had HS for years.
A culture, a lab test of the fluid that shows which germs are present, may be part of that visit. Once HS is confirmed, you have a clear answer to give your coach and the people you train with.
Herpes and ringworm have their own time-off rules
Herpes gladiatorum is an HSV-1 skin infection that shows up most often on the head, face, and neck, where tie-ups put faces together. Since it spreads skin to skin, NFHS skin infection guidelines keep high school wrestlers out at least 10 days after a first outbreak.
Ringworm in wrestlers, also called tinea gladiatorum, is a fungal infection. The same guidelines call for antifungal treatment before a wrestler returns to practice.
When a boil needs a doctor soon
A few warning signs for boils mean you should contact a clinician promptly, including any of these:
A fever along with a boil
Red streaks spreading out from the sore
A large, swollen pocket of fluid
A boil on your face or spine
Book a visit with a dermatologist, too, if a boil hasn't healed after a week of home care or keeps coming back after treatment.
If a new lump shows up mid-week
Say you find a sore lump under your arm on Tuesday and you have practice Wednesday night. A few simple steps take care of your skin and the people you train with.
Leave it alone, because squeezing or popping a lump can injure or irritate the skin.
If it hurts, hold a warm compress on it for about 10 minutes.
Cover it with a dressing if it's open or draining.
Let your coach know, since the CDC asks athletes to report possible skin infections to a coach, athletic trainer, or doctor.
Get it examined before you roll.
Take a photo and note the date, and keep doing that with each flare.
That last step pays off at your visit. HS is diagnosed through a skin exam and your history, so photos and a timeline of your flares give your dermatologist a clearer picture. For how to bring it up with your coach, see the coach section below.
Looking after your skin around practice
Good habits before and after training lower the chance of infections moving around the room. They can also leave HS-prone skin less irritated.
Shower soon and wash gently
Try to shower soon after training instead of sitting through the drive home in wet spats, which is also what the exercise recommendations suggest. Use a gentle wash, because AAD's HS self-care tips point out that scrubbing causes inflammation that can make HS worse.
Antimicrobial washes, such as a benzoyl peroxide wash or a zinc pyrithione soap, are worth asking about at your next visit. Whatever you use, pat dry afterward, including the folds of your groin and armpits, and change into something dry and loose.
Leave lumps alone instead of squeezing them, even when one sits right where your belt ties. Keep your own towel, bar soap, and razor, too.
What to wear, and how to prep your skin
Wash rash guards, spats, shorts, gis, and belts after every session. Get them out of your bag when you get home so they don't sit damp overnight.
Rash guards and spats are tight by design, so ask your dermatologist about fit and fabric before you buy a new set. Moisture-wicking fabric is worth bringing up at the same visit.
A few minutes of prep before class helps too. The exercise recommendations suggest anti-chafe balm on friction points, such as your inner thighs or wherever your gi collar rubs, before you start.
If you use antiperspirant, choose one without alcohol, baking soda, parabens, dyes, or fragrance. Skip waxing altogether, and if you shave areas where HS flares, take your time to avoid nicks.
If a spot is open or draining, cover it with a dressing before you step on the mat.
What to ask your gym about mats
The CDC's advice for coaches is to clean shared equipment after each use and let it dry before anyone uses it again. It's reasonable to ask your gym how often the mats get cleaned and disinfected.
You can also wear sandals whenever you step off the mat, bathroom included. Wiping down shared pads and bags before and after you use them takes a minute.
Talking to your coach about HS
It helps to bring HS up with your coach early, before a training partner spots a bandage and starts wondering. Lead with the diagnosis, keep it short, and say what you'll do if a spot drains.
You could say something like, "Hey coach, I've got a skin condition called HS. My dermatologist checked it, and it's not contagious. If a spot starts draining, I'll keep it covered or sit out the live rounds."
Your coach also has to think about everyone on the mat. The CDC's standard for coaches is that a wound needs a dressing that holds all the drainage and stays on, or the athlete sits out. A coach may apply that to any draining spot, so a draining HS lump can keep you off the mat until it's covered or settled.
With teammates, a one-line version of the same message is usually plenty.
Should you train through an HS flare?
No one has studied this in grapplers specifically. So the answer comes down to where the flare is, how much it hurts, and whether anything is draining. Talk it through with your dermatologist and decide together what the week should look like.
That might mean drilling instead of rolling, steering away from positions that grind on the flare, or taking a few days off. When you can, scaling back instead of stopping can help keep your timing and conditioning close to where you left them.
Conditioning that's easier on HS
Off the mat, there are good ways to keep your conditioning up while a flare settles. The expert exercise recommendations favor activities with little skin-on-skin contact, such as swimming. Tono's guide to workouts that are easier on HS goes into more detail.
Swimming and water workouts help limit overheating and sweat build-up. Skip shared pools while a spot is draining, and shower and dry your skin folds well afterward.
A stationary bike is low impact, and riding indoors keeps the temperature easy to control. The saddle presses on the groin and buttocks, though.
Strength training in short sets with rest tends to build less heat than long cardio. Machines and resistance bands let you control range of motion and stop short of a painful stretch.
Yoga, Pilates, and tai chi keep heat low, as long as you modify poses that press on or stretch a flaring area.
Body-weight work at home is another option on days you'd rather not be in a hot gym. What fits best depends mostly on where the flare is.
Where the flare is | May be harder to tolerate | May be easier |
|---|---|---|
Armpits | Overhead presses, pull-ups, some rowing movements | Walking, the stationary bike, lower-body strength work |
Groin, buttocks, or inner thighs | Cycling saddles, rowing seats, deep squats, lunges | Upper-body work, swimming, machine moves with a shorter range of motion |
So if your armpits are flaring, you might put pull-ups and overhead presses on hold and ride the bike or train legs. If it's your groin or inner thighs, upper-body days and the pool may sit better than squats, lunges, or the rower.
Planning around a tournament
Tournament week goes more smoothly when the planning starts a few weeks out. Competition skin rules may differ from gym practice and can vary by event, so check your organizer's rules as soon as you sign up.
Then talk with your dermatologist weeks ahead about timing treatment around the date, and ask whether a note confirming your diagnosis would help. Go in knowing that a draining lump may get a closer look, whatever is behind it.
How a dermatologist can help you stay on the mat
Dermatologists spend years training in conditions of the skin, hair, and nails. That depth matters with HS, because HS can look a lot like ordinary boils. A dermatologist can diagnose HS through a careful exam and your history, adding a culture when infection is a question.
Treatment depends on how active your HS is. It can include medicines that calm inflammation, biologics (medicines that target specific parts of the immune system), and in-office procedures. Before your visit, you can read how HS treatment options compare.
The goal is fewer flares and fewer missed sessions. Bring your training schedule to the visit, along with the positions you spend the most time in and where lumps tend to show up.
At Tono, dermatologists who focus on HS diagnose the condition, manage biologics, and step up treatment when it's needed. You stay with the same team over the long term, and when you need a procedure, they arrange it.
Much of that care can happen by video, which makes check-ins between flares easier to fit around practice. Cultures and procedures happen in person.
Getting started is straightforward, with appointments in 2 days or less, no referral needed, and most insurance accepted. Every visit, from the first exam to each follow-up, is led by a specialist.
Frequently asked questions
Can I catch HS from the mat or a training partner?
No. HS is an inflammatory condition, not an infection, so it doesn't spread to the people you train with. A lump that turns out to be an infected boil can spread, which is why new ones get checked.
Why do I keep getting boils from jiu-jitsu or wrestling?
If you have HS, the heat, sweat, and friction of rolling can set off flares in the same skin folds again and again. Recurring boils can also be infections, so an exam is how you find out which one you're dealing with.
Can I compete in wrestling or BJJ tournaments with HS?
That depends on the event, because many organizers set their own skin rules. Rules such as the NFHS guidelines for high school wrestling focus on contagious skin infections. Since an HS lump can look like a boil, it helps to have your diagnosis confirmed well before you register.
Can I cover an HS lump and keep rolling?
That's up to your coach and the event rules, and a secure dressing is the starting point. Ask your dermatologist which dressings stay on best through sweat and scrambles.
Can I lift weights during an HS flare?
Strength training with machines, bands, or body weight is one of the options that may be easier on HS, as long as you adjust for where the flare is. Swap out moves that press on or stretch the flaring area until it settles.
Which doctor should I see for boils that keep coming back?
A dermatologist, ideally one experienced in HS. They can work out whether your lumps are HS, an infection, or both, and treat each one.
See a dermatologist experienced in HS
If boils keep interrupting your training, a Tono dermatologist experienced in HS can see you virtually or in person. Find a dermatologist to book a visit.
