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 major differences in what comes out.

“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 how and when an HS lesion may fill with blood, how to manage drainage, and when you may need to seek medical care.

Understanding HS Boils and Lesions

HS is a chronic skin condition characterized by inflamed or infected hair follicles, leading to painful boils, nodules, cysts, or bumps. Symptoms typically occur on the areas of the body where the skin rubs together, such as the breast, groin, inner thighs, buttocks, and armpits. Boils in HS can range from the size of a pea to a large, painful, oozing abscess.

It’s classic for these boils to fill up with pus, which is a thick, yellow or green fluid. Pus is a response to your immune system’s white blood cells attacking foreign bacteria, causing the buildup of immune cells, bacteria, and tissue debris.

However, many people may find that their drainage is more pink or red, or even appears to be more blood than pus. In many people, large abscesses or infected HS lesions will 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 8 hours straight!”

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 to know 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 severe 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 — This brings blood vessels closer to the infection and increases the likelihood of leakage through the blood vessel walls.

Managing Drainage

Managing boil drainage from HS lesions is an integral part of coping with the condition. Follow the instructions provided by your health care professional. Some general tips for managing the drainage of an HS boil, especially if it is 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 Seek Medical Attention

Occasionally having blood-filled lesions that stop bleeding after a short period of time may not indicate a medical emergency. However, due to the risk of blood loss or infection, certain signs and symptoms warrant prompt medical attention. These include:

• Excessive bleeding — Bleeding for hours, even after applying pressure to the wound to stop the bleeding, may indicate a greater underlying issue and increased health risks.
• Increased pain and swelling — If a lesion becomes increasingly painful, swollen, or inflamed, even after it’s drained, this may indicate a secondary infection.
• Fever and chills — These are signs of an infection that has reached your bloodstream and requires treatment from a medical professional. Treatment will often include the use of oral antibiotics.
• Difficulty in movement — If the lesion is affecting your daily life, including your mobility, see a dermatologist to get it drained in a sterile environment.

Treatment options for infected and painful lumps include:

• Sterile drainage of existing boils
• Topical and oral antibiotics
• Injected steroids
• Biologics

Talk With Others Who Understand

On myHSteam, the social network for people with hidradenitis suppurativa and their loved ones, more than 41,000 members come together to ask questions, give advice, and share their stories with others who understand life with hidradenitis suppurativa.

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, or start a conversation by posting on your Activities page.