Say the real thing out loud
You keep a spare shirt in your bag. You check your shadow-side before you stand up in a meeting. You have worked out which fabrics hide a wet patch and which ones announce it. You do laundry constantly and separately. You have a system of dressings, pads, or folded tissue, and you know exactly how long each one lasts. You plan your seat, your clothes, your day, and sometimes whether you go at all, around whether something might leak or whether someone might smell it.
And you have almost certainly decided, somewhere along the way, that this is a personal failure. That if you were cleaner, this would not be happening.
It is not a hygiene problem. It has never been a hygiene problem. Understanding what is actually leaking out of you, and why it smells, takes some of that away, so here it is.
What is actually draining
A draining sinus is an epithelialised tunnel under your skin with an opening onto the surface. It was built by repeated follicular rupture: a blocked follicle bursts, spills keratin and debris into the deep skin, your immune system attacks the spill, and after enough repetitions your body lines the channel with skin cells and gives it a permanent vent.
That tunnel is now a container. It collects shed keratin, hair fragments, dead immune cells, tissue fluid, and the proteins broken down in a chronically inflamed pocket. Pressure builds. It vents. What comes out is not simply pus in the ordinary sense; it is the contents of a chronically inflamed, chronically filling space. Sometimes it is thick and yellow. Sometimes it is clear and watery. Sometimes it is blood-stained. Sometimes it is stringy. All of that is normal for HS.
Why it smells, and why washing harder does not help
The odour is chemistry, not dirt.
A tunnel is a low-oxygen space. The organisms that thrive there are anaerobes, and anaerobic metabolism of proteins and keratin produces the specific compounds responsible for the smell: sulphur-containing compounds, short-chain fatty acids, amines. These are produced inside the tunnel, below the surface, in an environment that soap will never reach. You could shower six times a day and change nothing, because the smell is being manufactured somewhere your washcloth cannot go.
What scrubbing does reach is your skin barrier, and there it does damage. Aggressive washing, harsh antiseptics, and antibacterial scrubs strip the lipids that hold the barrier together. A stripped barrier is drier, more fragile, more permeable, more easily irritated by friction, and more prone to occluding follicles. People trying hardest to wash the smell away are often, unknowingly, feeding the process producing it.
Gentle cleansing. No scrubbing. No antiseptic soaking. No shaving over active areas.
What actually reduces drainage
Drainage volume is a function of how much inflammatory material the tunnel is being fed. Reduce the feed, and the tunnel drains less, hurts less, and stops recruiting new territory.
That feed is systemic. HS is not a skin condition with systemic complications; it is a systemic condition expressing itself through the skin, and its inflammatory load is driven by gut health, hormonal balance, immune regulation, metabolic function, and stress and cortisol load. We build treatment from your driver profile rather than the diagnosis label.
Phase L, Lowering the Load, uses oral Inflammatory Load Reduction formulations to bring down inflammatory signalling. Phase I, Internal Correction, addresses the drivers over the following months. Phase F, Functional Clearance, is a set of oral formulations and is not a procedure; it is added only when L and I are stable, because introducing it early mobilises more load than your system can clear and worsens active drainage. Phase E, External Tissue Repair, is a topical you apply at home over draining and healing areas. Phase S, Remission Maintenance, is a tapered oral phase.
For drainage specifically, the sequence usually shows itself as less volume, then less odour, then longer dry stretches between vents, then fewer active openings.
Honest limits
An established tunnel is a structure. Reducing what feeds it can make it quiet, and quiet is a genuine, life-changing outcome. It does not guarantee the channel itself will close. In extensive EPOH-DSS Stage 4 Advanced Tunneling, some tracts will need a surgical opinion, and we will tell you that rather than let you spend a year finding out. Continue any medication you have been prescribed unless the prescriber changes it.
Expect a Partial Improvement Plateau around weeks three to six, where the early gains stall. It is not failure and it is not the ceiling. It is where people quit.
Where to start
Bring the practical details, how often you change dressings, how much, what colour, what smell. It is diagnostic information, not embarrassment. Assessment is by video consultation, and follow-up runs on WhatsApp. Your formulations are couriered to you. There is no procedure and no clinic visit at any stage.
