Hidradenitis suppurativa (HS) is a chronic skin condition that causes boil-like lumps underneath the skin.
Lesions can show up on different parts of the body, but HS typically occurs around the:
The condition can become severe over time. Although it can be difficult to manage, a dermatologist can help you develop a treatment plan for swelling and inflammation.
As the HS lumps become larger, they sometimes fill with pus, which a healthcare professional might drain. Here’s what you need to know about safe HS drainage, including when it’s recommended.
HS occurs when the protein keratin blocks hair follicles, leading to an overgrowth of keratin, oil, and sweat. This can cause bacteria to grow, which can lead to infection and inflammation.
Risk factors for HS include:
- being female
- having a family history of HS
- having a personal medical history of:
- severe acne
- inflammatory bowel disease
- overweight or obesity
Although HS can cause pus-filled lumps under your skin, the condition doesn’t always present itself this way. The severity and extent of HS can vary from person to person.
One person living with this skin condition might develop clusters of small blackheads on their skin, whereas another person could have pea-size lumps. Skin lumps can also increase in size, become painful, and sometimes rupture.
It’s not unusual for tunneling to develop underneath the skin, too. This connects one lump to another.
Sometimes, a dermatologist will perform an incision and drainage. This is a minor surgery used to release pressure and pus underneath the skin. This procedure can also relieve pain.
While this is a possible therapy, drainage isn’t considered a first-line treatment for HS.
This procedure can offer temporary relief, but abscesses often return. Incision and drainage can also raise your risk of infection, even with the use of sterile instruments. An infection can also occur because incision and drainage doesn’t involve stitches, so the wound remains open while healing.
If you have recurrent boils or cysts, repeated draining in the same general area can also trigger the growth of scar tissue. This will make it harder to remove the lump at a later time.
Extra scar tissue can create additional tunneling underneath the skin, as well as fistulas. These are atypical connections that form underneath the skin.
A dermatologist may recommend drainage in cases of severe discomfort. Drainage can quickly relieve pressure and pain. However, the procedure doesn’t always provide lasting results, which means the lump can return.
Treatment for HS depends on the severity of your condition. If you have mild symptoms, you might relieve them with an over-the-counter (OTC) topical antibiotic and pain medication. Pain medication helps reduce swelling and inflammation.
Sometimes, though, HS doesn’t respond to these therapies. See your doctor for lumps that are painful or don’t improve, or if you have repeated flares.
Your doctor can diagnose the skin condition and recommend additional therapies. These might include:
- steroid injections
- biologics (therapies that target the source of inflammation)
- systemic retinoids, such as isotretinoin
- hormone therapies, such as oral contraceptives and spironolactone
- laser hair removal to destroy hair follicles
- prescription pain medications
In severe cases, your dermatologist might suggest excision. This involves complete removal of the lump, and the wound is then stitched and closed. This procedure is for lumps that don’t improve with treatment.
Your dermatologist may also recommend a surgical procedure known as deroofing, which is the removal of the skin that covers sinus tracts or abscesses.
Your doctor might first recommend allowing a lump or abscess to drain naturally. If incision and drainage is necessary, though, you should schedule this appointment with a dermatologist. These doctors are familiar with these procedures, and using a dermatologist can lessen the risk of complications.
Some people might see their primary doctor or visit the emergency room or an urgent care facility for drainage. However, not every doctor is qualified to perform this procedure.
The procedure involves your doctor first applying a numbing cream to your skin, then making an incision in the boil and allowing the pus to drain. They do not stick or sew the wound closed.
Don’t pick your lumps or attempt to drain HS yourself. This can cause an infection to spread to other parts of your body.
As you wait for your HS symptoms to improve, you can take other self-care measures to relieve symptoms. This includes applying a warm compress to lumps for 10 minutes a few times each day. This can help the boil drain on its own.
You can also lessen inflammation and flares by keeping your skin cool. Avoid wearing too many layers, keep your environment as cool as possible, and limit sweating.
Wearing loose clothes might also ease symptoms, as well as quitting smoking (if you smoke) and losing weight (if necessary for you).
HS is a chronic skin condition that affects people differently, and symptoms can worsen over time. When OTC remedies fail to work, a dermatologist might recommend other treatments like prescription pain relievers, antibiotics, biologic therapies, and even excision.
Incision and drainage can improve symptoms like discomfort, but it’s not a definitive treatment for HS.
If you have a painful lump that doesn’t respond to home treatment, make an appointment with a dermatologist to discuss all available treatment options.