Updated: Jun 30
Hold on to your hats and glasses, this is a LONG article that contains A LOT of information, all things wound care. Please check out the PRODUCTS page for a list of some of the products mentioned in this article.
With HS we know that relief typically comes when the abscess has drained. We’ve all asked ourselves "How do I get this wound to heal?” or “I've had this hole/wound forever, what do I do?". Some wounds heal quickly while others can take quite a while; the same theory applies to people’s ability to heal in general.
**ATTENTION** This article does NOT apply to a surgery wound or a large or deep wound.
Please follow your physician’s instructions for healing those wounds. This is a general guide for normal HS wounds.
The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read in this article.
If you think you may have a medical emergency, call your doctor, go to the emergency department, or call emergency immediately.
In this article you will find tips on:
Helping get an abscess to drain
Treating abscesses not ready to drain
Seeping and/or oozing abscesses
Healing drained abscesses
Healing the “holes”
Treatments for rashes and itching
Other product recommendations
Wound supply recommendations
Other treatment options
Other ways to help control inflammation can be found here
ABSCESSES CLOSE TO DRAINING OR READY TO DRAIN
Apply continuous moist warm/hot compresses/packs. Your main goal is to get the abscess as soft as possible so it starts to drain.
Moist packs can be made out of the following to promote drainage:
Apple Cider Vinegar
Turmeric Medi-honey (products can be purchased from store)
Bread and milk packs (bread soaked in milk)
Bath Options to Help with Drainage:
Apple Cider Vinegar Bath: 1-2 cups of apple cider vinegar and soak for 20 to 30 minutes.
Diluted Bleach Bath: Add ¼ - ½ cup of common 5% household bleach. Soak your torso or just the affected part of your skin for about 10 minutes. Rinse off with fresh water. Warning: Limit diluted bleach baths to no more than twice a week. Do not submerge your head and be very careful to avoid getting the diluted bleach into the eyes.
Himalayan Salt or Sea Salt Bath: Add approximately ¼ cup of Himalayan and/or sea salt. Soak 20 to 30 minutes.
Epsom Salt Bath: Once tub fills about halfway add 1 cup of epsom salt and give it a few big stirs with your hand to help it dissolve. Soak 20 to 30 minutes.
Epsom Salt Detox Bath: 1 cup epsom salt, ½ cup of baking soda,4 Tablespoons of ground ginger (more or less depending on your tolerance). Once the tub fills about halfway add all ingredients and give it a few big stirs with your hand to help it dissolve. Soak 20 to 30 minutes.
Note: The ginger in this detox bath will make you sweat! Sweating is one of the best (and cheapest) ways to detoxify, and if you don’t have access to a sauna, this is a fantastic alternative. Another bonus: It’s a powerful antioxidant with potent anti-inflammatory properties and is amazing for your skin as well.
If you’ve never done a detox bath before before limit the soak time to 20 minutes and only use 4 Tablespoons of ginger. You may continue to sweat for an hour or two after your bath. The more ginger you add the more the bath will cause you to sweat. Drink plenty of water afterwards.
Drawings Salves to Help Promote Drainage:
Quret Drawing Salve
Note: If your abscesses are not ready to drain, stay away from heat as it causes inflammation and will only make the pain worse.
ABSCESSES NOT READY TO DRAIN
Use ice packs, which can be used anytime during a flare to help with inflammation and pain. Be sure to place a barrier (washcloth, towel, etc.) between your abscess and the ice pack so you do not burn your skin with the ice pack.
If you are able to take Ibuprofen, you can take up to 800 mg (prescription strength). Keep in mind that hidradenitis pain comes from inflammation so helping to bring the inflammation down will help with the pain of the flare.
If you have one deep under the skin, the best thing to do is leave it alone as there is very little you can do for this type of abscess. The more you irritate these the more angry you will make it. If you're experiencing pain, the best bet is a drawing salve, ice packs and some ibuprofen (or other NSAID).
SEEPING OR OOZING ABSCESSES & HEALING AN OPEN WOUND
One of the biggest mistakes people make with their abscesses is that they do too much, which keeps the wound irritated and open. Another common mistake is not using the proper bandages. Stay away from bandaids they trap a lot of moisture, which harbors unwanted bacteria. Stay away from antibiotic ointments and keep your wound care as simple as possible.
Use saline and/or saltwater to wash the wound 1 to 3 times per day (recipe below). After washing the wound, take a piece of gauze which is cut to size, place it on your wound and secure with tape (try not to use too much tape to avoid irritation). If you have a wound that is draining or seeping you can follow the above and also cut a piece of an ABD pad as an extra barrier and place it on top of your gauze before securing with tape. If you don’t have the supplies on hand Viva paper towels work in lieu of gauze.
If the wound is sticking to the bandage when removing. You can use a small amount of Vaseline on the area to keep it from sticking.
Let your wound air out when you have the opportunity, for example, at bedtime. After a couple of weeks, if you do not see any improvement, you can incorporate Colloidal Silver Gel into the routine one to two times per day.
If your wound is going on several months and or up to a year without healing and is causing your problems, speak to your dermatologist about possible steroid injections in the area to help promote wound healing. Debridement may be necessary, which is a more invasive approach, but sometimes necessary, especially after surgery.
Protein is especially important while healing. You can get protein through a variety of different foods and/or protein shakes; keep in mind that most protein shakes are high in sugar. Read more about protein HERE. Mineral supplements should be avoided unless you are deficient, however, if you find yourself stalled in the wound healing process, Zinc and vitamin C can be beneficial.
Iodine solution (or any antiseptic)
Note: Do not use antiseptic excessively so as to not kill the good bacteria. Read more about this HERE.
Using too many new products at once can make it so you don’t know which product/regimen is working and what is not, and it can also get quite costly. Pick a soap you want to wash with and then pick a particular item, such as an antiseptic, ointment, or a cream etc. If you're chosen regimen is not working after time then try another combination changing out only one product at a time. It requires diligence to find the right combination of products for your HS. Read more about product suggestions HERE.
Help with Itching
Regular or mint toothpaste
Benadryl (non drowsy allergy)
Help with Pain:
Note: Do not use Vicks or lidocaine on open abscess, too close to your genitals, or on mucous membrane areas; please also use in moderation.
Soothing Irritated Areas or Rashes
Skin barrier wipes
Any unscented regular soap
Black African soap
Castile (Dr. Bronner's)
Colloidal silver soap
Some people like Fels Napa and/or Zote soap. The UK equivalents to Zote is Dettol and/or Asda.
NOTE: Fels Napa and Zote (and UK equivalents) can be harsh. Hibiclens and antibacterial soaps should not be used excessively so as to not kill off the good bacteria. More HERE.
Bandages and Wound Care Supplies
Check with your doctor and see if you are able to get medical supplies written as a prescription to try and get it covered under insurance; the worst that can happen is it will get denied and you’ll still have to purchase them out of pocket.
Skin barrier wipe if you're sensitive to tape which is a way to protect skin from body fluids, adhesives and friction. Forms a breathable, transparent film for long-lasting protection. Works even when applied over an area with bends or creases. Barrier Film can be used on both intact and damaged skin.
Other Treatment Options
Steroid Creams and Injections: If you have a doctor and/or dermatologist there are prescription topical options, preferably steroid-based/non-steroid based, as they help with inflammation. You can also talk with your provider about steroid injections.
Biologics: There are also different biologic options to consider. More HERE.
Hormones: If hormones are a trigger for you, there are hormone therapy treatments. More HERE.
Sweating: If sweating is a trigger, there's Botox. More HERE.
Surgery: There are surgery options depending on your severity. More HERE.
Avoid lancing and/or I&D (incision and drainage), which should be a last resort. More HERE.
Wear any type of cotton (breathable) bike or yoga shorts. You can also take leggings and cut them into shorts. These make such a difference for you when you have abscesses in those areas; not only does it help with pain, it helps with friction as well, will also help hold bandages in place and can somewhat conceal smells and drainage. The same goes for above the waist, anything cotton and semi tight fitting can help with friction, as well as all of the above mentioned benefits.
Things to Avoid
Shaving: Use a trimmer instead
Deodorant: If you can get away without using deodorant that is highly recommended, especially for those with Stage 3. If you must use deodorant, please make it is as natural as possible and aluminum-free.
Picking: Do not mess with them, pick at them, or squeeze them.
DIY Saline Solution
Mix one cup of warm water and approximately a half teaspoon of salt (preferably sea salt or Himalayan salt). This can be stored for up to 15 days in an airtight container.
Wound care is a standard part of HS, no matter what stage. Please do not self lance and if you suspect cellulitis with any abscess, please see medical attention ASAP.
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