Lancing and I & Ds for HS
Should you get your abscesses lanced, drained or get an I & D (incision & drainage)? Only if absolutely necessary and unfortunately, pain does not always qualify as necessary!
We understand that lancing (I&D) are sometimes necessary; there are times when an abscess is infected and this procedure is required or if you have a large abscess that has been going on too long and the pain is completely unbearable. If an I & D or lancing is required in your case, please contact your dermatologist prior to going to the ER or Urgent Care as they are not qualified to perform a proper I & D.
Repeated lancing in the same areas should not be used as regular maintenance for hidradenitis, which is now being realized. These procedures are very risky, even in a sterile environment and done by professionals. Self lancing or using a needle is never advised.
The impact of an I & D may happen over time; every time you lance in the same area or close to the area the scar tissue starts to build up. The more scar tissue that builds up causes tunneling to occur. If you are at stage 1 or a mild stage 2, for example, with no scar tissue/tunneling or minimal scar tissue/tunneling, you have now set the stage for abscesses to form in other areas and the surrounding areas. This means you are putting yourself at risk of advancing the severity of your disease and your HS stage. Another common issue that develops as the result of lancing or an I & D is the development of a continuously draining abscess and open wounds which can be very hard to heal. These types of issues don’t require multiple I & Ds, this can happen after only one lancing procedure.
In addition to the above, you increase the chance of developing fistulas (a fistula is an abnormal connection or passageway that connects two organs or vessels that do not usually connect). Lancing or I & D of a perianal abscess (anal areas) can result in a chronic anal fistula and may require a fistulectomy by a surgeon. I & Ds should be avoided in this area if possible.
Lancing and I & Ds are one of the worst things you can do for hidradenitis, which is why so many doctors and hospitals will not do it. We’re told by our dermatologist or the hospital that it is best to let the abscesses drain naturally. Any physician who knows this disease typically uses these methods as a last resort or know when it’s appropriate. You also run the risk of hindering future treatment options based on I & Ds or self lancing. Should you need wide excision or CO2 laser surgery scar tissue build up from self lancing or I & Ds could make the surgery more difficult or result in a more invasive surgery with a longer recovery.
Please keep in mind when “giving your opinion, suggestions, promoting, urging, or encouraging" others to do this, you have no idea what their situation is.
- Are they new to this disease?
- What is the status of their abscess?
- Do they have any other medical conditions?
If you choose to have your abscesses lanced or have I & Ds, regardless of the risks, this is your prerogative, however, please do not encourage others. Those new to HS may be inquiring about this practice as they’ve seen this mentioned in groups, please do not encourage this form of disease management.
Surgical Procedures article here.
Treatment Journey Options article here.
HS and follicular occlusions here.
Interview with HS Surgeon Dr. Stephanie Goldberg regarding HS Surgery Misconceptions here.
Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.
Written by Denise Panter-Fixsen
Edited by Brindley Kons