Dressings and Wound Care Supplies for Hidradenitis Suppurativa

Introduction to Wound Care in Hidradenitis Suppurativa

The most important step in managing hidradenitis suppurativa (HS)-related wounds is to treat the underlying disease with appropriate medical and surgical approaches. Even so, proper local wound care is a key cornerstone of management for patients with HS, especially in those with advanced disease. Clinicians will encounter two types of wounds: typical or lesional HS wounds, and post-surgical wounds. The former can be further sub-divided into draining nodules and abscesses, draining tunnels, pyogenic granuloma-like lesions, and frank ulcerations (e.g., knife-like ulcers, pyoderma gangrenosum-like ulcers). Local wound care is instrumental to suppress potential triggers of immune dysfunction, manage exudate, reduce maceration, and decrease the likelihood of secondary infection. The benefits of such an approach include accelerated healing, decreased pain, optimized cosmesis, and improved quality of life. Lesional HS wounds cause pain, produce exudate and odor, and thus have significant and typically underappreciated effects on patients’ quality of life. Social embarrassment, decreased work productivity, and missed employment opportunities are commonly reported. Indeed, many patients with HS live with dressings that require frequent, cumbersome changes that further interfere with everyday activities.

Standard post-surgical wound care is well-established ; however, selection of an effective and comfortable dressing for typical HS lesions is often an overlooked dimension of care with immense potential to improve quality of life. Currently, there are no HS-specific dressings, which is a significant limitation especially with regard to the anatomical location of typical wounds in HS (i.e., skin folds). Therefore, when choosing a dressing for HS-specific lesions, clinicians should take into account the location and morphology of lesions, the degree of pain and inflammation, amount of exudate, odor, and the cost and availability of the product. The ideal dressing for HS-specific lesions should: appropriately absorb exudate to maintain healthy moisture balance, protect the skin from external trauma and infection; promote collagen synthesis and re-epithelialization; stay in place to avoid friction; and be appropriately shaped to fit curved locations if necessary. Selecting the optimal dressing for a given patient is challenging given that HS classically involves difficult anatomic areas (e.g., groin, axillae) and is characterized by fluctuating disease activity.

Evidence to support optimal choice of dressings for HS is scarce and limited to few small studies. Current knowledge is primarily derived from expert opinion and studies on acute wounds and other types of chronic wounds. Recommendations herein are thus based on synthesis of this available data by experts in HS and wound care.

Given lack of evidence and the heterogenous nature of the disease, it is unlikely that one dressing will fit the needs of all patients or lesions at all times. Therefore, clinicians must become familiar with the fundamental properties of the dressings available on the market and together with their patients build a regimen that will address the patients’ needs, dynamic as they may be. Key to a successful wound care regimen is the realization that typically, wound care is delivered by the patient on a daily basis, at home. Therefore, treatment planning should always begin with listening to the patient’s needs (e.g., work schedule, access to supplies and home care), assessing their health literacy and ability to care for their disease, and ensuring that the final treatment plan is practical. Clinicians should demonstrate dressing changes for the patients and provide written instructions, as well as other resources, in order to ensure the success of the wound care plan.

In this chapter, a lesion-based clinical approach is proposed for each type of HS wound. For clarity, the discussion is divided into management of typical lesions (e.g., nodules, abscesses, etc.) and post-surgical wounds. For each of these broad categories, descriptions and evidence levels for each type of dressing are provided, where applicable. All HS dressing discussed herein, their characteristics, and utility are summarized in Table 20.1 . Finally, an overarching algorithm for dressing selection in HS patients is outlined.

Dressings for Typical Hidradenitis Suppurativa Lesions

Typical HS lesions to consider include acute inflammatory nodules and tunnels both acute (flared) and chronic. Acute HS nodules tend to be painful and have minimal to no drainage. Given these characteristics, acute nodules would most benefit from non-adherent dressings with cooling effect such as hydrogel or hydrocolloid dressings. These atraumatic dressings will limit skin damage and minimize trauma and pain with dressing changes. In case drainage occurs from a nodule, foams may serve as an added padded layer on the affected skin, further aiding with pain management and providing excellent absorption.

Flaring tunnels are often associated with pain and heavy drainage. Dressings of choice for these lesions therefore include absorbent and superabsorbent dressings (see section “Absorbent Dressings for Typical HS Lesions”). Chronic tunnels, that is, those which have failed to heal by approximately 40% within 4 weeks, ought to be treated as chronic wounds. Chronic wounds typically exhibit increased fibrinogen and fibrin, which are thought to impair the wound healing process. Chronic wounds are also at risk of infection, and may require debridement. Depending on the amount of drainage, hydrocolloid dressings (see section “Superabsorbent Dressings for Typical HS Lesions”) or foams (see section “Foam Dressings for Typical HS Lesions”) can be beneficial for these, as they can facilitate wound healing by assisting with autolytic debridement.