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 when they do start leaking, you might notice that what comes out can vary.

“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.”

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

– A myHSteam member

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.

Understanding HS Boils and Lesions

HS is a long-term (chronic) skin condition that causes inflammation around hair follicles. This leads 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 that forms when bacteria enter the body and cause an infection).

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

However, some people notice their drainage looks pink, red, or more like blood than pus. In many people, large abscesses or infected lesions may contain a combination of both 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.

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

Some say it depends on the part of the body it’s located in: “Mine in the groin and butt area swell, burst, and bleed a lot.”

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

“Mine in the groin and butt area swell, burst, and bleed a lot.”

– A myHSteam member

How Do Boils Fill With Blood?

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

Blood-filled lesions may occur due to various reasons. These include:

• Tunnels under the skin that connect lumps with blood vessels — This is more common in people who have had a severe case of HS for many years.
• Lesions growing into large, infected abscesses
• 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 larger 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 and coping with the condition. Follow the treatment plan provided by your healthcare provider. Some general tips for managing the drainage of an HS boil, especially if it’s filled with blood or actively bleeding, include:

• Wash your hands with antibacterial 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.

Most wounds will eventually drain on their own at home.

When To Talk to Your Doctor About Bleeding Lesions

Having a blood-filled HS lesion now and then — especially if it stops bleeding quickly — may not always be a medical emergency. But because of the risk of blood loss or infection, it’s important to know the signs that mean you should seek prompt medical attention right away.

Contact your doctor if you notice any of the following:

• Excessive bleeding — If a lesion keeps bleeding for hours, even after you’ve applied pressure, it could point to a more serious issue. Ongoing bleeding can lead to shock, which can be life-threatening.
• Increased pain and swelling — If a lesion becomes increasingly painful, swollen, or inflamed, even after it’s drained, it 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. Oral antibiotics are often used in this case.
• 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, like 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.

Connect With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 46,000 members come together to ask questions, give advice, and share their stories with others who understand life with HS.

Have you ever had an HS lesion fill up with blood? What advice do you have for others living with HS to relieve their symptoms? Share your experience in the comments below, start a conversation by posting on your Activities page, or connect with like-minded members in Groups.