If you’re living with the symptoms of hidradenitis suppurativa (HS), you know that not all HS lesions look or feel the same. Some take longer than others to drain, and the fluid can look different from one lesion to the next.

“Does anyone have boils that fill up with blood rather than pus?” one member of myHSteam asked. “I am finding a repeating pattern of having boils that go large and firm with pus and then go down and fill with blood. They don’t ever burst, but the skin is very thin and very painful.”

In this article, we’ll explain why some HS lesions might fill with blood, how to care for draining wounds, and when to talk with your doctor about what you’re experiencing.

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Understanding HS Boils and Lesions

Hidradenitis suppurativa is a chronic (long-term) skin condition that causes inflammation around hair follicles, leading to painful boils, nodules, cysts, or bumps. Symptoms usually show up in areas of the body where skin touches skin — like under the breasts, the groin area, inner thighs, buttocks, and armpits.

Boils in HS can range from the size of a pea to a large, painful, oozing abscess (a swollen, pus-filled lump).

It’s common for HS boils to fill with pus, a thick yellow or greenish fluid. Pus forms when the immune system sends white blood cells to fight bacteria. This leads to a buildup of immune cells, bacteria, and dead tissue.

Some people notice drainage that looks pink, red, or more like blood than pus. Large abscesses or infected lesions often contain a combination of blood and pus.

Members Discuss HS Boils Filled With Blood

Many myHSteam members report developing HS lesions containing blood. “I do have boils that are full of blood. Most of them are. Very seldom do I get one with both blood and pus,” one member said.

“Does anyone have boils that fill up with blood rather than pus?”

— A myHSteam member

Another shared that every lesion is different: “Sometimes it’s pus, sometimes blood, sometimes sebaceous, sometimes solid.”

Some say that bleeding depends on the affected part of the body: “Mine in the groin and butt area swell, burst, and bleed a lot.”

Others say that their skin bleeds for a while after a lesion has broken open: “I had one that burst yesterday, and it bled for eight hours straight!”

How Do Boils Fill With Blood?

The color and consistency of fluid may vary from person to person and from flare-up to flare-up. Seeing blood in an intact boil or bleeding after a lesion has broken open can be concerning. It’s important to understand how this symptom occurs and what to do about it.

Blood-filled lesions may develop for various reasons, including:

• Lesions growing into large, infected abscesses
• Tunnels under the skin that connect lumps with blood vessels — This is more common in people who’ve had a severe case of HS for many years.
• Ruptured blood vessels within the affected area — Blood may combine with pus when draining out.
• High degrees of inflammation — When skin is inflamed, the blood vessels grow and leak more, bringing in extra blood and immune cells.

Managing Drainage

Managing boil drainage from HS lesions is an integral part of self-care. Follow the treatment plan provided by your healthcare provider. To manage the drainage of an HS boil, especially if it’s filled with blood or actively bleeding, try these general tips:

• Wash your hands with soap and water before touching the lesion.
• Keep the area clean with gentle soap and water.
• Use sterile dressings on affected areas of skin to absorb drainage.
• Apply warm compresses to relieve pain and promote drainage.
• Avoid tight clothing, and wear loose-fitting clothes to reduce friction.

When To Talk to Your Doctor About Bleeding Lesions

A blood-filled HS lesion that stops bleeding quickly may not be a medical emergency, especially if it only happens occasionally. However, because of the risk of blood loss or infection, it’s important to know the signs that mean you should seek prompt medical attention. Contact your doctor if you notice any of the following:

• Excessive bleeding — A lesion that keeps bleeding for hours, even after you’ve applied pressure, could point to a more serious issue. Ongoing bleeding can lead to shock, which can be life-threatening.
• Increased pain and swelling — A lesion that becomes increasingly painful, swollen, or inflamed, even after it’s drained, may be a sign of a secondary infection.
• Fever and chills — These symptoms could mean an infection has entered your bloodstream and needs medical treatment, such as oral antibiotics.
• Limited movement — If a lesion makes it hard to move around or do your daily activities, it’s time to see a dermatologist. They may need to drain it in a sterile setting to help you heal safely.

Treatment options for infected and painful lumps include:

• Sterile drainage of existing boils
• Topical and oral antibiotics
• Injected steroids
• Biologic medications (to help reduce inflammation in moderate to severe HS)

HS boils and lesions can be painful, persistent, and affect your quality of life — but there are ways to manage them. Talk to your doctor about tips for wound care and what warning signs to watch for.

Some HS risk factors, such as family history, can’t be changed — but your doctor may help you find lifestyle or environmental triggers that can be addressed to reduce the severity or frequency of flares.

Join the Conversation

On myHSteam, people share their experiences with hidradenitis suppurativa, get advice, and find support from others who understand.

Have you ever had an HS lesion fill up with blood? Let others know in the comments below.

Still have questions about your condition? I can help.