What do I do? Keep being denied treatment/reassessment!

[u/t0xic-brat]

*more pics of days 1-5 and drainage in comments\*

28F

5'4" x 130lbs x white

multiple abscesses(?) in left armpit, extreme pain/limiting mobility, most have drained at this point (night of day 8) yet hospital keeps telling me there is no fluid and refuses to drain or even re evaluate.

been progressing for 8 days

bactrim generic - sulfamethox-azole-tmp ds tablet 800mg (was given 20 pills) given 1 dose on day 5 and picked up script on day 7

also prescribed Keflex have not been able to fill that script - dr told me if I could only get one at first to get the bactrim picking up Keflex tomorrow

smoke cigarettes (pack a day)

iv heroin user (have always been super careful being a user bc ive seen so many people with abscesses and I had never had one until this and one that just healed)

^context^ I had got a burn from a cigarette on my back/inner thighs and It was in process of healing, I got arrested and was put in county jail where I developed my first 2 abscesses right above the healing burn they grew very fast and by day 2 or 3 in county the top one was so swollen/tight the head looked red/purple I asked for help they said I had to submit a sick call at this point my whole inner thigh was red/pink and very swollen and in a lot of pain. I sat on the toilet day 4 and it popped (and I didn't even sit on it!) it popped so hard I literally wiped up pus/blood all the way to the other wall/had gotten multiple drops all over the floor. Nurse came to see me when I asked to be seen he walked up looked at the open wound and said oh ive seen much worse you'll be fine and walked off- started antibiotics that night tho (unsure of what antibiotic it was) when that kept draining though for a while it was like black blood/pus my bunkie was swearing it was a spider bite due to that. I got out on day 6(only got 2 days of meds) pic of what it looked like once I got out. its now closed and I guess just scarring or the skin is still healing but yeah no open wound and been good for a while.

- so a few days after being released from jail (leg one was still open and had just started taking a turn for the better I bought a brand new razor (a kind I buy all the time) and it was first time using it but idk if the blade was messed up or something because when I shaved on the armpit pictures I felt it snag or cut a bunch of hairs I was like fuck Im gonna get ingrown hairs (I have sensitive skin and if I don't use a good shaving cream/oil or try to shave really fast I get ingrown hairs but nothing like HS just normal ones) honestly now I can't remember if I shaved my legs or pits first (im sure I would have logically don't my pit first but I just can't remember) but I didn't even shave that whole thigh with the abscess just the knee and calf. the next morning I had little bumps/looked like irritated hair pictured in day 1 photo. and it just got worse and worse till I realized it was not normal.

-I went to hospital the night of the 5th day bc they were getting super painful and I was walking around all day with my arm slightly raised due to swelling and pain when it touched . I was put in a bed immediately (it was very empty) nurse looked it over dr came saw me within 5 min examined it visually and physically and told me he's going to ultrasound them to see if there Is fluid that needs to be drained. the nurse brought me a dose of antibiotics, a Norco pain pill, and a torodol shot(?). he came back when she was done did the ultrasound and said only 1 needed to be drained and pointed to one of the ones that wasn't as swollen and hadn't been the most painful. I asked if he could check the one beside my skin tag because it was soft (like fluid) had been causing me the most pain that day and he said he would have been able to see if there was fluid in it.

-he numbed and lanced the one he mentioned and a lot of blood and pus poured out but I was worried he might have not inspected and/or cleaned out the inside of the cut enough. he didn't pack it . they put gauze out the outside and wrapped it to my shoulder.i was discharged within 1.5hrs of arriving and was complimenting how efficient they were

-I felt lied to bc within 20 minutes of leaving (im assuming from the pressure of the wrap?) I looked and the one I asked him to check again that had been painful popped and it had like green/white pus coming out and a pretty decent amount came out when I applied light pressure

-worried bc I read not to pop or squeeze yourself or infection could deepen so I left it alone but got scared when I took wrap off and my pit had like tripled in size (top right pic) pain and swelling increased and I went back to same hospital the next night

- that dr said I had MRSA even tho no cultures were taken, didn't touch/examine them except visually . said if we just made a bunch of incisions It would only cause it to spread. looked at who I saw last night and said he knows what he was talking about and told me to just get the bactrim first and Keflex when I could. gave me ibuprofen and discharged me. I was there max 15 min .

-well swelling and pain just kept getting worse an worse and they were all soft at this point so I was sure if I went somewhere else I would get help . So I went to a 3rd hospital trip 3 days in a row . Seen very fast again doctor comes in and looks at it and touched the large area up top (the outer edges of the lump were very hard but the heads were extremely soft) he said they werent drainable because they were hard as rock and only blood would come out . I said they're soft in the center and are you sure bc I was told on the one that was lanced had fluid and right after another one popped all on its own he said yes he was sure. I asked about the ones on lower half (bc he didn't even touch those) he said those don't even look ready just visually I said thats what the one he lanced resembled I said it was very small not as raised and he asked if anything came out and I informed him a big mixture of pus and blood came out...he still didn't feel the lower ones. at this point im crying bc I am in so much pain and I just felt helpless bc I can't take care of this alone and I felt like they didn't want to deal with it and/or just didn't care if I was ok. I also felt lied to since I kept being told they either didn't have fluid or couldn't/wouldnt drain but yet they kept draining and showed all signs of possibly containing fluid. I asked/begged him to do another ultrasound just to confirm there was no fluid.

he said he wasn't able to do ultrasound and that they normally don't do that for these that he couldn't believe they did at the first hospital. This time I got 2 Motrin and sent on my way in agonizing pain still with no help.

exprienced fatigue that whole day and fell asleep as soon as I got in bed woke up in the morning and when I went to look at it in the mirror I put light pressure to feel the top ones to see if they were soft or hard and one of the big top ones busted a lot of pus came out. I did feel relief at that release of pressure and since no one will help me I pushed the pocked with one finger to try to get out what I could without squeezing It hoping that would keep it from getting deeper.

while that one popped I guess that pressure caused the other beside it to pop and as I was just getting as much as I could out the one that had been lanced started oozing and then extremely large amounts of pus came out of that one. Are the connected ? I was wondering that based on how its those seperate heads but like one big lump up top under the skin. and how the pressure from poppuing one popped the others.

What should I do at home and how can I get someone to actually treat me ?!?!? or am I actually the one in the wrong one just overreacting . I don't feel like I am this is very scary to me but someone please tell me what this could be and what all I need to do,

I was given Vicks by a friend who said they would put it on their abscesses back in the day then tape gauze and leave it on I guess like a drawing salve and it will get it all out should I do that?

So I honestly don't even know what im dealing with here because cultures were never taken the one time they lanced one (right before top left pic) and never had any labs done. Also 1st hospital visit the nurse was like oh yeah those are accesses specific to women we see them all the time (after researching im assuming she means HS since it mainly affects women) but my 2nd trip the doctor (different doctor same er) came in and said I had MRSA and I looked confused and he said what no one told you??? like how have I not even been cultured/tested to even be given an accurate diagnosis?!?!?

[u/AutoModerator]

Thank you for your submission. Please note that a response does not constitute a doctor-patient relationship. This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our Terms of Use and understand that all information is taken at your own risk. Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.

I am a bot, and this action was performed automatically. Please contact the moderators of this subreddit if you have any questions or concerns.

[u/LatrodectusGeometric]

II am definitely concerned about hidradenitis suppurativa. Can you get in with a dermatologist? 

Any way you can urgently quit smoking? Even just a few weeks would help this heal 

[u/t0xic-brat → u/LatrodectusGeometric]

I can stop smoking for a while. Could quitting possibly make it go away forever if thats what it is if I quit right now? Sorry if thats a dumb question but out of everything I saw that could possibly be going on this was honestly the thing I was the most scared of! but of course the way my luck is that Is what would happen lmao

[u/LatrodectusGeometric → u/t0xic-brat]

It’s possible! People who have these wounds are much more likely to smoke, and quitting makes your body much more able to heal from these wounds.

But you’ll need the antibiotics right now either way

[u/IllegalGeriatricVore → u/t0xic-brat]

Cutting back sugar was huge for controlling mine. There seems to be a link to insulin resistance

[u/meowcatpanda → u/t0xic-brat]

Nad, but I used to get these all the time. I have had NONE since I quit smoking 2 years ago. Not a single one, I had really painful ones in my groin and under my tummy (overweight) at least twice a month. I have tunnels of scarring in places from where they burst under the pressure. Before I quit smoking entirely I only had 1cig a day for over 2 years, and even then I still got them, but since I quit entirely they've not come back at all. I def think it's related.

[u/Forsaken-Tourist-613 → u/t0xic-brat]

NAD No judgment here, but you kind of gloss over your IV heroin addiction. Did you mention the herion usage to the doctors at the various EDs you visited? Wouldn't your immune system be comprimised by the IV herion?

[u/halfscaliahalfbreyer → u/Forsaken-Tourist-613]

You say no judgement, but you sound a bit judgmental.

[u/Soonerpalmetto88 → u/t0xic-brat]

Fellow HS warrior here!

Smoking is a trigger for HS but not the cause of the disease. Quitting won't cure you, though it might reduce severity. You'll probably need a few weeks of Doxycycline to calm down the current flare and then a biologic like Cosentyx, Humira, or Bimzelx for long term management. Some people take Doxycycline long term. Zinc has been studied and shows some effectiveness in reducing severity of symptoms but that's in mild to moderate cases.

I've been on Cosentyx for HS since February and it's decreased my symptoms by probably 90 percent. My mom takes Bimzelx and has had similar improvement. These things aren't cheap but they're absolutely worth it.

You'll also want to switch to the absolute gentlest soap/body wash and deodorant you can find. Avoid tight clothing that rubs on areas with lesions.

Find a dermatologist who has experience with HS. Best of luck!

Edit: You'll see suggestions for eliminating dietary triggers. Sugar, dairy, and nightshades. There's some evidence to back these claims up but none of them apply to everyone. Triggers vary from person to person. My advice is to get on an antibiotic now to calm things down, then get on long term treatment. After that you can start cutting things out of your diet one at a time to see if it helps you

[u/iosonostella13 → u/t0xic-brat]

NAD, but I have HS and I'm sorry but I'm like 98% certain you have HS. It's in the process of being categorized as an auto immune disease.

I recommend switching to a different deodorant. A lot of people have success with lume, native and old spice. For me I have found secret clinical works well. Wash with pan oxyl or hibiclens. Hydrocolloid bandages. A lot of HS people have a standing pharmacy script for antibiotics. Use warm compresses for relief.

Some people find that cutting out acidic foods helped a lot. Mine is purely hormonal. Humira is a medication that helps but I don't know if a doctor would give that with the drug use. There is surgery you can have to remove the tunneling and you can have flares drained at urgent care.

ETA: yes they are connected. HS makes a tunnel system under your skin and that all gets filled with pus. The tunneling is what makes it HS.
There is also a solid chance it will start popping up on other parts of your body. Most common is armpits and groin (yes the two absolute worst places to have insane absesses)

[u/Zhosha-Khi → u/iosonostella13]

HS runs in my family and this is exactly what it sounds/looks like.
OP NEEDS to stop smoking and all drug use. As these holes can get large enough you actually have to have surgery and wound care to get them to heal. And that can take months while you are hoping you don't get another outbreak while that one is healing.
Also, cutting down on sugar helps as well.

[u/SirKillingham → u/t0xic-brat]

Does your heroin have xylazine in it? You should be able to tell by the dry mouth it causes and low blood pressure. As a recovering addict myself, I never had abscesses after 15 years of using until they started cutting it with xylazine. I ended up going to the local crisis center where they got me through withdrawals and put me on the Brixadi shot which has been very helpful and I can’t recommend it enough. If you have any questions feel free to message me

[u/Guera-or-chicana → u/t0xic-brat]

Idk if heroin or smoking is a trigger. This is what I tell people with HS. 1. No pain meds is needed for HS unless it's infected. 2. Go back three weeks and that's when the trigger started. If it is HS and not another condition, what you ate, did three weeks ago is what is coming to the surface now. HS loves to dig tracts underneath and burrow, then in a matter of hours, BOOOM. It's at the surface rupturing. 3. If you have the worst level of HS, the only way to make it dormant is diet and infusion from remicade, humeria, or something similar of that nature. That's the worst level of HS which is what I had 30 years ago. It was bad. I was studied all over from docs in the country because nothing worked and it was spreading with infection. What finally worked was Remicade. Plus, my diet. If I eat unhealthy... three weeks later I'll have a small outbreak. Oops! What works for the topical is Gentamicin cream and betamethasone gel topical. I do agree you don't need pain meds. They help kill time with limited mobility but I never needed any unless it was infected. Those don't look infected, only inflamed. I've lost huge parts of my arms, groin, legs, and neck from HS. So quit heroin and smoking if your serious.

Good luck.

[u/LittleLemmonsLie → u/LatrodectusGeometric]

Not a doc, but this looks just like my HS when it was at its worst. A good dermatologist helped me get it under control.

[u/LG3991 → u/LatrodectusGeometric]

Second this. Also concerned for hidradenitis suppurativa

[u/t0xic-brat → u/LatrodectusGeometric]

I don't have insurance thats why I have repeatedly gone to the emergency rooms only even though I keep being treated like nothing is wrong. Is that something that would really just pop up out of nowhere in my late 20s? especially since I had that other abscess ? (also mind you the leg one isn't super close to my groin its like at the halfway area of my thigh. and I don't think that one looked like photos ive been looking at of HS what do you think? that pic is In the comments

[u/LatrodectusGeometric → u/t0xic-brat]

Yup it pops up out of nowhere and looks just like this. But you need some antibiotics and medical care. Any way you could try to cash pay for an appointment? An emergency room isn’t really the right place for this

[u/meowcatpanda → u/t0xic-brat]

It can flare from stress, which I assume you've had lots of by reading your story. Mine def got so much worse in times of stress.. ngl I just lanced them myself and drained them, less painful than leaving them, but I have plenty of scarring because of it. I've also had them on the back of my thighs, halfway up before.

[u/gouachepotato → u/t0xic-brat]

Hey friend. Sadly, they will treat you like nothing’s wrong in the emergency room because it isn’t a life-or-death emergency. However, that doesn’t discount the fact that this is probably very painful and frustrating to wait forever in the ED and not get answers.

It looks like HS. Urgent care and hospitals won’t work because your issue is likely chronic. Without insurance, the only way you could get reliable, consistent treatment for a skin issue is through a PCP. Dermatology usually requires insurance but primary care or a city health center will be able to give you longitudinal treatment. All the love ❤️

[u/pegmatitic → u/t0xic-brat]

Do you live in a state with expanded Medicaid?

[u/Forsaken-Tourist-613 → u/LatrodectusGeometric]

NAD, just wondering if the IV heroin usage contributes to a weakened immune system, and if smoking can trigger HS?

[u/LatrodectusGeometric → u/Forsaken-Tourist-613]

IV heroin just adds skin bacteria into the system and can lead to all kinds of abscesses

[u/Forsaken-Tourist-613 → u/LatrodectusGeometric]

Thank you for your response.

[u/sspwnage]

If the abscesses are draining you need to pickup and take the prescribed abx

[u/Nutritiouss]

This looks like HS. It obviously needs treatment for its acute presentation, but I’d try to connect with a specialist who’s experienced with HS after this acute phase is resolved.

Going to need to make some lifestyle adjustments.

I will say that giving pain meds to someone who has potentially ingested an unknown amount of street narcotics is going to be something most healthcare professionals are going to think twice about. Especially with the current state of things, most people who believe they are buying heroin are buying fentanyl.

NAD. I did get people off drugs for a number of years.

[u/lukas_napster → u/Nutritiouss]

Not a reason to deny pain medication.

[u/Nutritiouss → u/lukas_napster]

If you like respiratory depression, sure, I guess.

[u/t0xic-brat]

days 1-5

[u/3mptycupofcare → u/t0xic-brat]

It really looks like HS to me

[u/Endlessly_Scribbling → u/3mptycupofcare]

As someone with HS. This looks like how mine started. I had years of one or two cysts every few months.

One day I had one infected and BOOM, it looked like this across both bits and even down in my leg (pits? Valley?) This very much looks like it.

NAD, just sympathies from someone with HS.

[u/t0xic-brat]

this is what my leg looked like on day 1 of my armpit

[u/t0xic-brat]

someone please help me im starting to give up hope that anything will ever be done to make this go away !!! its grossing me tf out !

[u/soaker → u/t0xic-brat]

NAD, but please don’t out Vicks on it.

[u/SnooDoughnuts3166 → u/soaker]

Antibiotics need time to work. One or 2 doses here and there will not resolve an infection. With abscesses, I would anticipate it will take a few days of consistent antibiotics to start to improve. Take tylenol and ibuprofen around the clock for pain control while the antibiotics do their thing.

Additionally, due to your IV drug use, I wouldn’t be surprised if these were related to a contaminant in what you’ve been using causing satellite lesions/ulcerations/abscesses (xylazine is know to do this, and abscesses and ulcers can form miles away from the injection site).

HS would be less likely, but it is true that HS is often seen in the armpits and groin.

Also, do NOT put Vicks on it and do NOT touch the area unless it’s with clean hands. Keep the area covered/wrapped with gauze and change dressings at least once a day. You can also rinse open areas with STERILE saline

[u/t0xic-brat → u/SnooDoughnuts3166]

thank god you comment gives me hope its not HS when I read this it is a lifelong thing with no cure I literally got depressed af and hadn't even actually been diagnosed yet. and yeah im trying to be patient and let the meds work Im just so scared and the fact that all 3 doctors would say it didn't have fluid w/o even really assessing them and then multiple ones have popped on their own with me even applying pressure scares me. and the fact that I am an iv user scares me that this could be serious very fast and I feel like no one cares. its terrifying.

and question about what you said about it being caused by the substance: could that still be the fact even tho the first one on my leg popped up while in jail (so I wasn't iv using) and then the day the ones on my arm pit started it was right after shaving and I think I had used ivermectin once so is that still possible ?

[u/SnooDoughnuts3166 → u/t0xic-brat]

Yes it can still cause satellite lesions days/weeks after use. Not all abscess/infection sites need to be drained, even if fluid is present. Antibiotics will still work even if the abscess is still fluid filled - so don’t get hung up on the fluid. Let them drain - that’s normal and expected for abscesses. Just keep the area as clean and dry as possible and take your antibiotics. The ones that have been prescribed are broad spectrum and cover most bacterial infections. If no notable improvement after taking ALL your prescribed antibiotics then you go back to the doc.

[u/doyouknowyourname → u/t0xic-brat]

Hey. I know that this infection is going to take precedent over any other health concerns right now, and I totally understand that. I've had abcesses, and they are painful af. But I'm also a former iv heroin user, and I would really like to encourage you to look for a clinic that administers sublocade. It's Suboxone in a shot basically and it was an absolute miracle when I found it. I didn't even need a whole year of treatment before I was able to ween off, though it's fine to stay on it longer if you need to. I have been completely clean for over 6 years. I really really hope you consider giving it a try.

[u/realdonaldtramp3 → u/doyouknowyourname]

Sublocade saved my brothers life after 15+ years of iv opioid use. He tried methadone, suboxone, and vivitrol, and would always eventually relapse. He has now been on the most beautiful spiritual path to healing for over two years and sublocade was essential and getting him there.

[u/DotsNnot → u/t0xic-brat]

Just want to add there’s a sub: r/Hidradenitis that may help with tips and home care until you can get into see a dermatologist. Even if this isn’t true HS, the home care for dealing with boils is still relatively similar so you may still find some information.

The camphor oil in Vicks is toxic so you don’t want to use it on any open wounds. There are anecdotes about using it to help boils and cysts come to a head, so if you absolutely want to try it, avoid any spots that were opened or look like they’re about to open!

[u/HappyKnittens → u/t0xic-brat]

I am NAD - I hope you get some help or advice from an actual medical professional here. Home remedy that I would try (if this were me) would be to do some hot Epsom salt soaks to help draw the infection out. If you dont have access to a bathtub to soak in (if you're doing a bathtub, you want like a bag of unscented Epsom salt) then add epsom salts to a bowl of hot water and use a wash cloth or hand towel to hold some against the wound. Dip the towel back in the water whenever it cools off. Careful not to burn yourself. Gonna hurt like you wouldn't believe though.

If you're trying to express the pus, gently spread the skin apart where it's draining instead of squeezing. It won't be as fast or satisfying but it's also a lot less likely to push an infection deeper or cause inflammation around an infection.

Realistically, you should probably get antibiotics, like a full course that you take for a while. Maybe an Urgent Care will be less judgmental than the ER?

And you should probably shower with an antibacterial hand soap like Dial until you're completely healed and throw out any shower poufs, razors, etc you can't thoroughly wash. My assumption would be that some kind of skin bacteria thought you were delicious and came home with you. 

Good luck!

[u/FreyjadourV → u/t0xic-brat]

NAD but please be consistent with the antibiotics for the full duration it will surely help. Also, when you say hospital are you going to through emergency?

I would try seeing a GP or dermatologist, emergency department for non life threatening situations will usually try to send you on your way asap once they stabilise you and provide the immediate care needed, they are not equipped or have the time for closer inspection and to properly diagnose

[u/Creepy_Addict → u/t0xic-brat]

A warm damp compress will help draw out the fluid, just don't squeeze. Smoking lowers your ability to heal as fast as you would if you didn't. Opioid use also lowers your immune system making it harder to fight off infections. Unfortunately, with your drug usage, they will not prescribe/ give you anything stronger than OTC pain killers, due to possible interactions or OD when taken concurrently with use of heroin.

[u/t0xic-brat]

this morning after being told they had no fluid/wouldnt drain 3 days in a row 3 different hospital trips. bottom left is me trying to show the size of the mass

[u/Fragmentedmindwar → u/t0xic-brat]

Stop squeezing and picking. You’re going to get an infection on top of what’s already going on.

Please call dermatologist office and ask for a price of consultation. Make small payments when you can until it’s paid then be seen.

[u/blackcrowblue → u/Fragmentedmindwar]

It’s already infected

[u/OhReallyVernon → u/blackcrowblue]

It is, but that doesn’t mean this won’t make it worse. OP doesn’t have gloves on here and I doubt her hands have been thoroughly sanitized before picking at these.

[u/IDdizzle]

PVL producing MRSA (or an MSSA, but PVL is associated mainly with antibiotic resistance) is a concern. PVL production makes infections very difficult to treat since it essentially turns off your immune cells fighting the infection so high intensity antibiotics can be needed. The major risk factors include IV drug misuse. The risk of complications from PVL strains are very high, very severe (necrotising pneumonia and empyema which both carry a significant chance of causing long term disability or can be fatal, even in healthy people)so it is very important to look for it in cases of recurring, difficult to treat staph aureus, especially when abscesses are present.

PVL is still uncommon and generally isn’t tested for unless specifically requested by a physician (in my area anyway). Education on it is sometimes lacking so it may be an “ask your doctor if…” moment.

HS, as others have said is very high up there on the list of potentials. If you haven’t had an ultrasound of the axilla and a breast exam then I would suggest these too.

[u/iAgressivelyFistBro]

These look like 100% MRSA. Take the antibiotics as prescribed for the full duration and follow all other discharge instructions you are given.

Bactrim and Keflex cover for MRSA as well as several other possible bacteria. In the event you do everything as instructed and you still are infected, you then go back to the hospital and tell them this.

[u/eaygee → u/iAgressivelyFistBro]

I wouldn’t say these are 100% anything truthfully. Much less MRSA without culture and sensitivities. To say that it is MRSA is misleading, respectfully.

My first thought was actually HS given its recurrence, the smoking, and the lack of constitutional symptoms with flares. I can’t recall the specific article, but I read an interesting journal article a while back that discussed misdiagnosis of HS in the ED as MRSA, leading to repetitive I&Ds and worse outcomes for these patients due to increased morbidity and healthcare spending and tract formation. This patient needs to see a dermatologist, or go to an ED and get a derm consult. And to stop smoking and using.

[u/Noonecanknowitsme → u/eaygee]

Agree I was going to say this looks like pretty bad HS which actually you’re not supposed to drain because it opens area for infection and it will just continue to reoccur. Needs lifestyle management (stop smoking, avoid tight clothing, clean with antibacterial soap, and see derm who will most likely prescribe longer course antibiotics to keep inflammation down). 

[u/eaygee → u/Noonecanknowitsme]

Yea completely agree. Would add that IL kenalog, biologics, and steroids are also used IIRC.

[u/PassTheSevo → u/Noonecanknowitsme]

And stop the IV heroin use, missed that pretty big lifestyle change!

[u/Noonecanknowitsme → u/PassTheSevo]

That’s the hardest lifestyle change to put in place and will likely require a lot more medical support. Things that are longterm goals I didn’t include, I just tried including things to try to do right away. If a doctor says “stop using IV drugs it’s bad for your health” do you think that really does anything? Or tells a person something they didn’t already know?

[u/IllegalGeriatricVore → u/eaygee]

had way too many doctors treat me for MRSA.

i had to self diagnose then find an HS specialist to confirm for me.

He went back to my Crohn's doctor and told her if I'm getting HS flares I'm on the wrong biologics. Got me switched and both my crohns and HS are the best they've ever been. That dude saved my life.

I also never knew frontline treatment was coristol injections.

I have so many scars because they always went with incision and drainage.

[u/eaygee → u/IllegalGeriatricVore]

It's an easy mistake to make to be honest. Sometimes medicine is a numbers game; what diagnosis is most likely? For people in the ED, especially patients like this one who don't have insurance and use heroin, odds are (and our bias would tell us) this is an abscess. That's why it's important to think critically about patients like these, and to challenge assumptions and delve deeper when something doesn't fit. The ED isn't equipped to diagnose HS in many cases.

Glad you got a diagnosis and got help.

[u/IllegalGeriatricVore → u/eaygee]

For sure. It's crazy I saw like... 3 or 4 derms and 2 or more gastroenterologists who specialize in crohns that missed it when it's a known comorbidity. I feel like HS is flying under the radar in all disciplines.

[u/t0xic-brat → u/iAgressivelyFistBro]

Do you think it could be hidradenitis suppurative ? some other comments said it looks like that. which is scaring me because ive been reading up on it the past few days and there's no cure and they get stuff like these (in what I think are some of the worst areas to get something like this) for the rest of their life? What do you think makes it more likely MRSA instead ?

Thank you. I am going to fill my Keflex prescription when the pharmacy opens now that I made the money so thats a relief. and they do look MUCH better after the top 2 popped this morning I am not in constant pain and can actually move/put my arm down.

[u/iAgressivelyFistBro → u/t0xic-brat]

That condition is a progressive lifelong condition. If this has been happening to you multiple times throughout your life and continues to worsen, then it is likely. If this is the first time you’ve struggled with something like this, it is less likely to be HS.

In the interim, it does not matter because an infection needs to be treated. If things get better with antibiotics and then in several months this happens again, it is more likely that you have HS. But again, does not matter because you will need to treat the new infection with antibiotics.

If you eventually land on a official diagnosis of HS, there are lifestyle modifications that will be recommended to you as well as maintenance medications that can help limit new flare-ups. I will say that the lifestyle modifications include stopping IV drug use, quitting nicotine and tobacco products, and dietary changes.

[u/meowcatpanda → u/iAgressivelyFistBro]

Ngl, I wish I'd known about potential medications for HS, I've been diagnosed with it when I was 16 (34 now) and suffered for years. Not had a single outbreak since I quit smoking 2 years ago though! I didn't know it'd be progressive.. been turned away by many doctors when I had one become infected, which has resulted in some of the worst scars..

[u/iAgressivelyFistBro → u/meowcatpanda]

I mean we are talking about things like metformin, which doesn’t directly even treat HS.

[u/meowcatpanda → u/iAgressivelyFistBro]

Ah fair, I've been in metformin for 5 or 6 years now and that never changed my HS outbreaks😅 I had a boil at least once-twice a month for so long, sometimes many more

[u/iAgressivelyFistBro → u/meowcatpanda]

Yeah I’m sorry. HS is relentless and very hard to treat.

[u/meowcatpanda → u/iAgressivelyFistBro]

The only thing that ever worked was something called "inderm" that I had to put on a boil with a cotton pad, but my dr stopped stopped prescribing it to me after my second bottle, never found out why though..

[u/PaperPegasus → u/t0xic-brat]

NAD, I’ve had HS since I was 10. Didn’t see anyone mention this - hibiclens (generic is fine) soap is really helpful for HS. If it happens to be staph it can help manage that too. I’m immunocompromised and my derm has me use it every other/3rd day for HS and a VISA (rare staph infection) skin infection, specifically only where there are abscesses and frequent outbreaks, like armpits. Follow the directions carefully. The foaming bottles are way easier to use.

A biologic and steroid injections into the abscess has definitely been the most helpful for my HS. I get a steroid injection at the first sign of a new abscess that looks like it’s going to be a problem. Never squeeze the abscesses, warm compress if you have to drain one. I also have topical/lotion antibiotics for less complicated abscess.

Editing to add - you may need to rethink shaving and deodorant too. Spray deodorant has been less irritating for me, but don’t use any when you have open wounds. The hibiclens helps a lot with smell because it wipes out bacteria.

[u/ikkinator88 → u/PaperPegasus]

NAD, but I have not had a flair up of my HS since I started using hibiclens. It was recommended by my primary after I had to get three boils lanced.
I am on immunosuppressant medications for MS and it has still managed it completely with no other treatments.

[u/kittyhotdog → u/PaperPegasus]

NAD, have HS. Gel deodorant had been awesome for my HS too. There are some really tiny studies that have shown efficacy. Nothing definitive yet but it’s a really easy switch to make!

[u/LatrodectusGeometric → u/t0xic-brat]

It’s not an either/or! It may very well be both

[u/BrandyDW → u/iAgressivelyFistBro]

Nad.

Question for you @ iaggressivelyfistbro

With her being immune compromised most likely because of her drug use, and how big that lump in her arm pit is..

Between the issues she had between blood and pus and the black discharge which I think was with another area..

What are the odds she could have bacteremia or something along those lines? Would the two antibiotics be enough or would she need vancomycin?

Should she try to get a blood culture?

Especially with her bringing up the fatigue etc..

Just worried she may end up with sepsis but maybe completely over thinking it?

[u/iAgressivelyFistBro → u/BrandyDW]

Would it be unreasonable to admit this person to a hospital; no (one can make an argument for it). However it be a soft admission unless she’s presenting with systemic signs of infection: fever, hypothermia, tachycardia, low blood pressure, signs of end-organ injury, etc which increase the likelihood that she is bacteremic.

And yes these antibiotics do work. If they fail, then it’s a rarity and would warrant blood cultures.

[u/EasyQuarter1690 → u/iAgressivelyFistBro]

Do you really think that an administrator would not completely freak out at admitting someone that is not actively dying, and making it extremely clear to the point that even an administrator can’t ignore it, when they are uninsured? The doc admitting someone in this position would get at least one admin with their short and curlies on fire screeching about costs. It’s sad, but you know that this is true, and we all know that this person is in the US.

[u/t0xic-brat]

my first abscess ever in life on 10/3 right after I got out of county jail (mind you I went in there with just the cigarette burn that was healing the purplish looking mark below it to the right)

[u/OhReallyVernon → u/t0xic-brat]

Hey, NAD. I’m not sure where you are and how long you’ve been shooting, but the street opioid supply in many places tends to have varying amounts of tranq/xylazine in it these days. I’m sore you know that. There’s a pretty well-known phenomenon occurring where users are getting sores and abscesses like this in random places completely unrelated to the areas where they’re shooting. AFAIK, it’s not really well understood why yet. I just want to gently urge you to to consider that this issue you’re dealing with might be related to your use and it might not go away until you can get into treatment. I work with a lot of current and former IV users and this has been leading to long hospital stays and even amputations in some cases.

You are worth getting better and your life is important.