Wound Care in Hidradenitis Suppurativa
What Is Hidradenitis Suppurativa?
Hidradenitis Suppurativa (HS) is a long-lasting inflammatory skin condition that causes painful, swollen bumps called nodules on the body. The bumps are mostly found in the folds of the body where two areas of skin rub together such as the armpits, under the breast, between the buttocks and in the bikini area. HS usually starts in a person’s teenage years and mostly affects women, and black and brown people. Sometimes, the inflammation of HS can also cause tunnels that can be felt under the skin. Skin can also become scarred and feel hard from new HS spots constantly coming and going.
Though these swollen bumps may drain fluid or puss and appear redder or darker than the rest of the body, HS is not caused by an infection but by the immune system not working right. Everyone has bacteria living on their skin which do not cause their immune system to react. In people with HS, their immune system reacts to these normal bacteria in a different way. This is what causes the inflammation that block the hair roots making the painful nodules of HS.
For a long time, many people including health care providers have been confused about HS and they still don’t totally understand why HS happens. However, we know that having HS is not the person’s fault. It is not caused by poor hygiene, and it is not a sexually transmitted disease. People with HS cannot spread it to other people through skin to skin contact because it is not contagious. Living with HS, especially when it is more severe, can be very hard; not only because of the pain, but because it can make it hard to go to work, school or do the things the person with HS enjoys. Dealing with this can cause people to feel sad, stressed or scared, which is completely normal. Talking to a doctor or joining a support group can help. Finding a good routine to care for HS bumps at home can also make it a little easier to live a full life.
Below are some tips and tricks that you may find useful in caring for your HS nodules between appointments:
· Keeping the area dry: The single most important care tip for HS at home is to keep these areas dry. Drying after exercise, swimming, showering, or any other time these areas get moist will help reduce any harmful bacteria or inflammation present.
· Sanitary pads: Becoming more popular because of online discussion, many people, not just women, have recommended sticking menstrual pads to clothing as an affordable way to keep skin with HS dry. Sticking pads to shirts in the armpit area, using panty liners in the bottoms of bras, and in underwear can help catch moisture. Because these products are disposable, they can be used and thrown away as needed.
· Antibacterial washes: Even though bacteria on skin, is not the only cause of HS, certain bacteria can make HS flares worse. Washes such as PanOxyl can be bought at stores like Walmart or Target for easy access. Stronger washes such as clindamycin washes can be given by a dermatologist and may be helpful in caring for HS at home.
· Silver dressings: Small, easy to apply silver dressings are great for HS wound care. They become activated by moisture and are anti-microbial meaning they stop bacteria and mold from growing However, this product alone can cost a lot over time, so this is great to use together with other products.
· Hidrawear: Brands such as Hidrawear are a great option of clothing designed to make caring for HS flares easier. While the cost may be the most expensive on this list, some insurances will cover the cost of buying clothing for a medical reason. People with HS can talk to their dermatologist and insurance companies to see if this is an option.
Overall, HS can be hard to care for. Having a good HS routine can make life with HS much better. Patients are not alone in this, and talking to a healthcare provider soon can make a big difference.
References
1. Kelly G, Sweeney CM, Tobin AM, Kirby B. Hidradenitis suppurativa: the role of immune dysregulation. Int J Dermatol. 2014 Oct;53(10):1186-96. doi: 10.1111/ijd.12550. Epub 2014 Jun 25. PMID: 24961484.
2. Poondru S, Scott K, Riley JM. Patient perspectives of wound care management in hidradenitis suppurativa. Arch Dermatol Res. 2023 Aug;315(6):1847-1850. doi: 10.1007/s00403-023-02576-8. Epub 2023 Feb 22. PMID: 36811730.
3. Antia C, Alavi A, Alikhan A. Topical management and wound care approaches for hidradenitis suppurativa. Semin Cutan Med Surg. 2017 Jun;36(2):58-61. doi: 10.12788/j.sder.2017.020. PMID: 28538745.
4. Moloney S, McGrath BM, Roshan D, Gethin G. The Personal Impact of Daily Wound Care for Hidradenitis Suppurativa. Dermatology. 2022;238(4):762-771. doi: 10.1159/000520262. Epub 2021 Dec 20. PMID: 34929704.
Written by: Dasia Byas and Elaine Flynn