Hidradenitis suppurativa (HS, or acne inversa), a chronic inflammatory skin condition, results from blocked hair follicles — typically in the armpits, groin, and other areas with many sweat glands and where skin tends to rub together. Painful lumps or lesions can develop under the skin, sometimes leading to bacterial infections like cellulitis. HS lesions can also cause tunnels called sinus tracts beneath the skin and develop into painful nodules or cysts, which may form abscesses and drain fluid.
Many people living with HS find it hard to deal with these wounds, particularly when they are open and ooze fluid (also called drainage, discharge, or weeping). The discharge may have a strong smell, which can be both uncomfortable and embarrassing.
Fortunately, a variety of strategies can reduce the amount of discharge and help you manage it when it does occur. Here is what you need to know about managing wounds with discharge while living with HS.
Dr. Chris Sayed, a dermatologist at the University of North Carolina School of Medicine Department of Dermatology, told myHSteam, “Generally, controlling the disease overall means less drainage.” This means that managing HS discharge starts with treating the condition itself.
Your health care provider may recommend or prescribe several medical treatment options for HS. These include oral and topical antibiotics, steroid injections, oral contraceptives, anti-inflammatory medications, biologic drugs, retinoids, and hormonal therapy. In some cases, surgical treatment is appropriate. It may take some trial and error to figure out what works best for you when it comes to treating HS.
You can take several steps to manage a breakout or flare:
To help reduce pain from HS, you can try applying warm compresses, using wraps and bandages, and taking over-the-counter pain relievers like acetaminophen (Tylenol) and ibuprofen.
Making lifestyle changes, such as losing weight and quitting smoking, could also help keep your HS under control. If you worry about taking on these challenges by yourself, talk with your doctor about getting medical support while you work toward your goals.
If you have an open HS wound, keep it bandaged as much as possible. Many myHSteam members wonder what type of bandage is best, such as one who asked, “Now that a lesion has ruptured and is draining, what kind of bandage can I use so it doesn't mess up my clothes?”
Several types of bandages or wraps can be used for HS wound care but may have pros and cons, according to Dr. Sayed: “Absorbent bandages can be helpful. ABD (abdominal) pads with Hypafix (dressing) tape are relatively inexpensive and pretty gentle on the skin, but bandaging areas around joints that are frequently in motion is difficult. Charcoal bandages are specifically intended to minimize odor but can be cost-prohibitive.”
It may take trial and error to find the bandages or wound dressings that are right for you. Some people prefer to use highly absorbent ABD pads, which are often coated with petroleum jelly so they don’t stick to the skin and can be taped down so that discharge and odor don’t escape. Others invest in more expensive bandages (for example, charcoal) to help manage a strong smell.
People have come up with creative ways to bandage HS wounds, according to Dr. Alexa Kimball, CEO and president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center and professor of dermatology at Harvard Medical School. “My favorite hack is to use menstrual pads in some of these areas. The nice thing about menstrual pads is they’re so cheap compared to bandages,” Dr. Kimball told myHSteam. She added that “nursing pads are another option — they’re not very expensive, nicely made, and a decent shape.”
Experts recommend washing wounds one to three times a day with a saline solution. This helps dry them out and promotes cleanliness and healing. Cover the clean, dry wound with your bandage of choice, first applying petroleum jelly if you’re concerned about sticking. Use extra-absorbent pads if needed, to contain drainage. However, continue to air-dry the wound when you can.
Dr. Kimball also recommended applying pressure whenever possible: “Apply pressure on the skin with a bandage so … the drainage keeps coming out of it. That’s where you want to use more absorbent bandages and, ideally — if you can, depending where (the wound) is — create compression to hold the bandages in place and keep the wound from reexpanding.”
Discharge can irritate the skin, she added. If you have a lot of discharge, use absorbent bandages to avoid ending up with a rash on top of the boil, she advised.
Many people with HS worry about the strong smell that can come from their wounds as much as (or more than) they worry about the discharge itself. When infected matter comes out of the body, as when an HS wound opens and drains, there’s often an unpleasant smell associated with it.
MyHSteam members frequently share their worries about this aspect of HS lesions and discharge. “I can’t take the smell today,” one member wrote. “I wash and wash, but there’s still this odor.”
If a wound opens in public or if a bandage doesn’t seal properly and you begin to smell the discharge, it can be embarrassing or uncomfortable. You can try some additional measures to address this issue.
Some medications specifically target “smelly” bacteria. These drugs could help reduce the number of those bacteria and, therefore, the strong-smelling infections they produce. “Sometimes, antibiotics such as metronidazole that target specific types of bacteria can help reduce discharge and odor,” Dr. Sayed noted. However, he added that “this isn't always a safe long-term option.”
You and your dermatologist should consider your options and choose the one that is the safest and most effective for you.
Another strategy that Dr. Kimball suggested involves sheets of plastic: “Take a reasonably absorbent bandage material and put it on the affected area, and then seal it with something like Tegaderm, which is a clear plastic adhesive sheet because then you’re essentially sealing it off temporarily.” This can help keep your wound clean and covered and prevent strong smells from escaping.
Some people with HS use natural methods — some of which also function as mild antibiotics — to eliminate strong smells from their wounds. You will need to make sure that you are not sensitive to any of these products before you use them on your body.
Ask your doctor about trying the following options:
As always, talk about your HS concerns with a dermatology expert. They can help you find solutions that will manage your discharge and its associated odor, all while helping your abscesses heal and improving your overall sense of well-being and quality of life.
If you or a loved one is living with HS, consider joining myHSteam today. MyHSteam is the online social network for people who live with hidradenitis suppurativa and those who love them. Here, you can share your story, ask and answer questions, join ongoing conversations, and connect with others who understand life with HS. Over time, you’ll build a network of people who will help you live well with HS.
Are you struggling to deal with discharge related to your HS and need encouragement or recommendations? Have you found something that works for you and want to share it with others? Share your questions, thoughts, or tips in the comments below or by posting on your Activities page.