Members of myHSteam report struggling with the burden of managing hidradenitis suppurativa (HS), particularly boils and lesions. These lesions, also called abscesses, can cause a great deal of pain, and can leak fluid and can smell. Members say one of their challenges is figuring out how best to clean and protect the lesions, in addition to relieving the pain.

One member asked, “Does anyone have any innovative ideas for dressing the HS wounds? These lesions will be in awkward places and nothing seems to stay in place there. My clothes get bloody and messy.”

Another mentioned, “I have never been told how to cope. Do I leave them alone? How do I clean or deal with them once they’ve burst? What can I do about the pain and swelling?”

Dr. Alexa B. Kimball spoke with myHSteam about the ways to manage leaking and painful HS boils and lumps at home. Dr. Kimball is a dermatologist and CEO and president of Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center. She is also a professor of dermatology at Harvard Medical School. Dr. Kimball has also researched and written about HS extensively, including a book titled, “Hidradenitis Suppurativa: Your Questions, Expert Answers.”

“I have never been told how to cope. Do I leave them alone? How do I clean or deal with them once they've burst? What can I do about the pain and swelling?”

— A myHSteam member

What can you do with a new boil that is inflamed, tender, or irritated?

A really simple, over-the-counter thing you can do — it’s not really potent, but it might help a little with the irritation around it — is to get some topical hydrocortisone, such as Cortaid 10, from the drugstore. And you might even get the ointment, because it helps to actually coat the area in a protective way as well. Hydrocortisone 1 percent ointment can help bring out some of the irritation, especially for the smaller ones.

What do you recommend for the pain from boils or lesions?

As the boils get a little bit bigger, there are also some over-the-counter pain creams that you can purchase too, such as Lidocaine 4 percent. Those are typically kept in the pharmacist’s area, behind the counter, or you can order them online.

You do have to put a thick amount on, and you have to cover it. It doesn’t kick in so quickly. It takes about half an hour to reach sort of a numbing capacity. What you want to do is put a bandage over the area, and let it really absorb, and that can give you some numbing relief too. However, you do have to be careful not to put it on too big an area, because you can absorb some of it. If you’re just doing a boil or two that’s fine.

If the boil is painful, but not near bursting, and you want to reduce pain, you can put something cold on it, such as ice or an ice pack. You can also use heat (a warm compress), but only if the abscess is very inflamed and is close to bursting. Heat is really something to think about if it is about to burst, where you can see that little head on top.

You have to learn through trial and error which is the right one to use at the right time. Because if you put heat on too early, you actually are going to make it more inflamed and hurt more.

Ibuprofen is probably the best over-the-counter pain medication for that as well.

What do you recommend when people with HS say, ‘I just want to squeeze the boil and get some relief’?

I like to give adolescent teenagers advice about acne. I basically say, “You get one try at a pimple and if it’s not easy to pop, then stop, because you’re going to make it worse.”

That’s sort of true for HS boils. If they have a head on it, you can apply gentle downward pressure around the edges of it and you can get it to drain. That’s OK. That’ll provide some relief. That means you already kind of have a hole there. But if you start squeezing it, you’re going to cause more inflammation and pain and actually make it worse. So you get one shot at it. And if it’s not easy, then stop.

Occasionally people say that they drain them with needles and other things. You have to be so careful. I have definitely seen people get rip-roaring infections from that. So I don’t recommend doing that.

Are steroids appropriate for reducing inflammation?

Dermatologists will sometimes inject steroids into the inflamed boil. Similarly, you can actually get much higher potency steroid creams like the hydrocortisone I talked about — but a prescription level. Your dermatologist or even your primary care provider could prescribe that for you, and you can use it for just a few days at a time.

What do you recommend doing when the boil is leaking or bursting?

The problem with bursting and leaking is it also refills. Ideally, what you really want to do is apply pressure on it, so that it can’t reaccumulate and the drainage keeps coming out of it. That’s where you want to use more absorbent bandages and ideally — if you can, depending where it is — create compression to hold the bandages into place and keep the wound from reexpanding. That is what is going to be the most helpful. I recognize it’s easier said than done, given where some of these are located.

You also have to recognize that the leakage is really irritating to the skin. That’s why having absorbent bandages is important, because you can get a pretty rip-roaring rash around the area just because the drainage is so irritating. Sometimes, the pain from the rash is worse than the pain from the boils.

What are the right kinds of bandages to use on HS boils?

There are many kinds of bandages out there. Basically what you need to think through is: Do you want something that is really absorbent or do you want something that is really designed to heal an open wound? Some patients do get these open wounds that take a long time to heal. However, most of the time, the issues have to do with drainage.

Alginate bandages, which are basically a seaweed compound that expands with the fluid that drains from the abscess, are helpful. Some of the gel or foam-type bandages will absorb as well. What you’re looking for is something that is highly absorbent.

Colloid or hydrocolloid dressings tend to be used more for extensive wound healing. They actually hold the fluid in place a little bit, and they don’t really take the drainage away from the skin. In a really big draining area, you’re not going to want to do that.

Do you have any hacks for bandaging HS boils?

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. They are easily accessible. They have obviously been designed for sensitive skin areas. They have a sticky backing so you can be creative about how you use them. It can be a much less expensive way to manage some of these things. The Always Infinity brand is a kind of foam, rather than a traditional cotton pad. That one rolls up nicely, and you can do all sorts of stuff with it.

Nursing pads are another option for people. They’re not very expensive, nicely made, and have a decent shape, so that’s another thing to look for.

How do you recommend cleaning the boils or lesions?

You don’t want to scrub. It can be pretty painful too. Use gentle cleansers or Head & Shoulders shampoo. And again, not going at it in an aggressive way, but letting water and soap rinse over the area to just get the drainage off. That can be really helpful.

If the wounds are very painful because they’re open, you can use saline instead. That can reduce the pain quite a bit. Because the reason the water hurts is that it’s just a different salt concentration than saline is. As a hack, you can buy saline in the drugstore and get a turkey baster and squirt it on. Or you can buy saline solution for eyes. You can get one of those containers with a squirt bottle already, and you can use that to clean some of them and you can get a little force from the liquid as well. Of course, you can make your own saline too if you need to.

How do you keep the HS boils near the genitals or buttocks clean and protected?

First of all, it’s painful to go to the bathroom.

One of the tips I often say is Vaseline. It has no allergens. It has no fragrances. I recommend that people actually put it on a tissue and wipe the [groin and buttocks] area before they go to the bathroom. And that’s because then you get a little bit of a barrier between the urine (which really can sting a ton) and the skin. That can be helpful in terms of cleaning the area. And then put Vaseline back on another tissue when you wipe. That also helps to not have the friction of the rough cloth, and it’s a pretty good way to clean.

And creative bandaging becomes a kind of an art form. For people with a lot of drainage in that area, sometimes they go for adult diapers. Also, there are all sorts of new underwear options for women, such as menstrual underwear, that are designed to be much more absorbent. So I think being creative about it is totally appropriate.

“Creative bandaging becomes a kind of an art form. For people with a lot of drainage, sometimes they go for adult diapers. There are all sorts of new underwear options for women, such as menstrual underwear.”

— Dr. Alexa B. Kimball

What do you do if a boil has burst and it smells?

One strategy is to 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 so that the smell isn’t permeating out of it, but you’ve got the absorption inside. It helps to change the pads more frequently if you can, but you know if you’re at work or in certain situations, that’s going to be tough.

What do you recommend for body odor more generally?

Odor is caused by a bacteria that is there that is essentially hanging out and creating that smell. So that’s why when you shower, you get rid of the odor because you’re essentially rinsing it off and then it comes back.

There’s a difference between antiperspirants and deodorants. Antiperspirants reduce sweat, and deodorants are fragrances that mask the odor. Masking the odor is not likely to be super effective in HS. Antiperspirants that decrease the sweat are important.

Now, there’s a lot of myths out there that deodorants are bad for HS, because they clog pores, which is part of the way they work. But what I tell patients is to get the clinical strength deodorants. There are some that are creamy, and they’re pretty nonirritating. Try it in a small area.

You don’t have to just limit it to under the armpits. You can use it in the groin, inner thighs, you can use it under the folds, you can use it on your feet — anywhere that is stinky and sweaty. I recommend a different one for your feet. You could have five different ones for different body areas. But deodorants can be quite effective. And most of them actually work better if you use them at night than during the day to activate. So that helps with the sweat, that’ll help with the bacteria, and that’ll help with the odor.

Bodywashes that have an anti-yeast or antibacterial effect can be helpful with odor too.

Are there specific products you recommend people with HS stay away from?

The older version of antiperspirants contained aluminum chloride, which stings like heck, and will sting like heck on normal skin, not to mention HS skin. That’s why I like the newer deodorants which are zirconium-based, like Secret Clinical Strength and Dove Clinical Protection. They are really much less irritating. Try it in a small area, and make sure you don't have a problem with it.

Not all of my patients follow through with it, they’re still kind of nervous about it, but I’ve definitely had patients say that it really did the trick for them.

What is the impact of hair removal on HS? Is it safe to do?

Because HS often occurs in areas where unwanted hair grows (such as the armpits, thighs, or along the bikini line), it’s important to talk about safe ways to remove that hair.

We recommend hair removal with some caveats. The reason that it helps is probably multifold. The hair follicle and the hairs are in a place where bacteria and yeast live, so it keeps things a little bit cleaner and easier to manage. There’s also no friction from the hairs getting moved around.

Hair removal works best with a laser, if there is a difference in hair color versus skin color. It works best when there’s dark hair and light skin, because in that setting, it’s attuned to the darkness of the hair, and it’s not confused by the skin color. It does take several treatments typically, but it is a nice way to reduce hair. However, it is expensive.

If you don’t do laser hair removal, I don’t recommend shaving. Because the hairs retract, you can get ingrown hairs and other issues. So no waxing, and no shaving unless you use an electric razor. You can clip, but we don’t want you to pluck or wax. That actually is pulling the hair out where it has to regrow.

And there are some at home devices as well. Some are better than others. They won’t usually permanently remove the hair, but they can reduce it.

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