Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition that causes painful, deep-seated lesions primarily in skin folds like the armpits, groin, and under the breasts. It begins when hair follicles become blocked, leading to a buildup of cellular debris beneath the skin surface, followed by a rupture of the follicle. This initiates a significant inflammatory response in the surrounding tissue.
The initial lesions are often deep, firm, and tender lumps called nodules that can persist for weeks or months. As inflammation progresses, these develop into abscesses, which are painful collections of pus that create intense pressure. This pressure eventually forces the abscess to rupture and leak fluid, a mixture of pus and blood, which provides temporary pain relief through spontaneous drainage.
Chronic inflammation can lead to the formation of sinus tracts, which are small, hollow tunnels beneath the skin connecting multiple abscesses and nodules. When a lesion spontaneously drains, it may leave behind an open wound that can be malodorous and prone to recurrence. Recognizing this cycle is the first step in managing a flare.
Safe Home Management for Symptom Relief
The primary goal of home care is not to force a lesion to drain, but to manage the pain and inflammation associated with a flare-up. Applying a warm compress is a recommended supportive measure for active lesions. Use a clean washcloth soaked in warm water and gently place it on the affected area for ten minutes, repeated several times a day, to help reduce swelling and discomfort. This heat can also promote the natural softening of the lesion, which may encourage spontaneous drainage.
Gentle and consistent hygiene is important for managing the skin surface without causing irritation. Wash the affected areas once daily with a mild, non-soap cleanser or an antiseptic wash, such as those containing chlorhexidine or zinc pyrithione, to help reduce the surface bacterial load. HS is not caused by poor hygiene, and scrubbing the skin aggressively will only worsen inflammation. For pain not relieved by warm compresses, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) can help manage discomfort and swelling.
Once a lesion has opened and is draining, keep it clean and covered with protective, non-adhesive dressings to absorb the fluid and prevent friction. Never attempt to squeeze, lance, or “pop” an HS lesion at home. Forcing drainage can push bacteria deeper into the tissue, increasing the risk of severe secondary infection, widespread inflammation, and permanent scarring.
Clinical Procedures for Lesion Drainage
When a lesion is acutely painful and not resolving with home management, a medical professional can intervene to provide drainage and relief. One common procedure is Incision and Drainage (I&D), where a doctor cleanses the area, administers a local anesthetic, and makes a small cut to allow the pus to drain. This offers immediate pain relief by reducing the pressure within the abscess cavity.
However, I&D is typically not a definitive long-term treatment for HS lesions because the recurrence rate is extremely high. It is best utilized for acute, painful abscesses in early-stage disease to manage symptoms quickly. For chronic lesions or those involving recurring tunnels, a more complete surgical approach is often considered.
Deroofing, also known as unroofing, is a more effective procedure for addressing chronic lesions and sinus tracts. This technique involves removing the “roof” of the tunnel or abscess while leaving the healthy tissue at the base intact. The wound is then left open to heal naturally from the bottom up, which significantly reduces the chance of recurrence compared to I&D.
Patients should seek immediate medical attention if a lesion shows signs of a spreading infection or systemic illness. These signs include:
- A high fever above 101.5°F (38.6°C)
- Rapidly spreading redness or unusual warmth extending beyond the lesion
- Foul-smelling or greenish drainage
- Severe pain not controlled by medication
These symptoms indicate a potential complication that requires urgent professional care.