No, our abscesses are not always infected. Typically our abscesses are sterile, for example, if an abscess was to be cultured there would be no harmful bacteria found in an HS abscess.
Usually only one kind of pathogenic bacteria causes infection in a wound, however, there may be several types of normal skin bacteria present in the culture as well. Testing to separate the various types of bacteria and identifying the pathogenic bacteria requires one or more days.
When normal/harmless bacteria is found the culture would be negative for: staphylococci, micrococcaceae, corynebacteria, ect. Harmless bacteria can possibly cause a false/positive as can a contaminated culture, however, a contaminated culture does not mean infection is present.
Non-bacterial abscesses can develop when certain fungi, viruses and parasites provoke pus formation in the skin. Heat, topical applications, systemically administered drugs and some injected materials can do the same.
Certain inflammatory skin diseases can have bacteriologically sterile pustules and can cause tissue destruction and abscess formations in the absence of pathogens (infectious microbes).
Acne conglobata and acne fulminans
Crohn skin disease
Panniculitis (inflamed subcutaneous fat)
HS lesions/abscesses can become infected. A few things that increase the risk for HS patients:
Picking at your abscesses
Squeezing your lesions
Lancing at home or using a needle
Not keeping the abscess area properly cleaned (especially after it's recently drained)
Sometimes they become infected without any of the above. The infections that occur with our abscesses are typically cellulitis. There is additional information available on this in other articles. Short-term antibiotics are typically given in cases of infection.
There are some HS sufferers who unfortunately deal with chronic infections such as chronic staph, chronic MRSA, ect., with their HS abscesses and in other areas of the body. Their cultures will most likely always have some type of bacteria present, even with antibiotic use.
Some HS sufferers also have chronic bacteria show up in cultures (not necessarily infection), as well as biofilm (which is pretty much antibiotic-resistant across the board).
HS patients are not always infected. It is imperative that you pay attention to your body and the way your HS abscesses act so you can identify if your abscess could be infected.
This is an awareness article for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.
Written by Denise Panter-Fixsen
Edited by Brindley Kons