Hidradenitis suppurativa can cause slow-healing wounds. Learn how to promote healing and prevent infection.
Hidradenitis suppurativa (HS) is a chronic skin condition marked by abscesses in areas where skin rubs together, such as the armpits or groin, according to the American Academy of Dermatology. These lesions can leave behind rupturing wounds and form tunnels that drain pus, says Christopher Sayed, MD, an associate professor of dermatology at the University of North Carolina School of Medicine in Chapel Hill. Silicone Foam Dressing
Sometimes severe HS is treated with surgery to remove tunnels and scarring, notes the Mayo Clinic. This treatment can result in deeper wounds that can take weeks or months to heal, Dr. Sayed says.
It’s important to properly care for wounds from HS in order to promote healing and prevent infection. Use these wound care tips to stay comfortable, shield your clothing from leakage, and protect your skin from irritation and infection.
1. Talk to your doctor for tips on caring for your specific wounds. The recommended dressings and cleaning instructions might vary a bit based on the severity and depth of your wounds, where they are located, and how well they are healing.
For example, just after surgery, you might need a dressing that absorbs drainage, but after a few weeks, when the wound is dry, a slim bandage might be sufficient.
“It has to be tailored to what’s going on with your skin in the moment,” says Sayed.
2. Clean your wound about once a day. After surgical treatment, it’s usually recommended to wash your wound once a day with soap and water, says Joslyn Sciacca Kirby, MD, associate professor and vice chair for education in the department of dermatology at Penn State University in State College, Pennsylvania. The goal is to remove any buildup of liquid draining from the wound and any petroleum jelly used to keep the wound moist. (More on that to come.)
3. Wash gently with mild soap and water. A mild cleanser is fine, says Sayed. There’s no need to use harsh soaps, scrubs, or rubbing alcohol. “Occasionally patients will use harsh chemicals, but most learn pretty quickly that if they’re too rough on that skin, it’s just going to make things worse,” says Sayed.
Remember, too, that cleaning wounds aids healing, but it won’t make HS go away. “There’s often this misconception even among medical providers that there’s a problem with hygiene in these patients, and I always tell patients that if hygiene fixed HS, there’d be no HS,” says Sayed. “The first thing that these patients or anybody else does if they’ve got pus draining from an area is try to keep the area clean and protect it the best they can. But it’s not as simple as that.”
4. Use petroleum jelly to keep wounds moist. Apply a thin layer of petroleum jelly, which can feel soothing and even aid healing, suggests Sayed. “A moist wound base is usually more ideal for healing than if it sort of dries out and crusts over, and a big scab forms,” he says.
Plus, if you place a dressing directly on a wound with no protective petroleum jelly layer, the dressing can stick to the top layer of skin, making dressing removal painful later.
5. Choose the right dressing. After applying petroleum jelly, top the wound with a dressing that will absorb fluid. “What can be challenging is that a wound after surgery and the wounds from the inflammation of HS can create a lot of liquid, a lot of drainage,” says Dr. Kirby. “So we need something to catch that, because if it just sits against the skin, it’ll cause more irritation to the surrounding skin and sometimes get in the way of healing.” Your health insurance might cover dressings made of highly absorbent alginate or foam, says Kirby. If not, simple gauze can work well.
Use a gentle medical tape to affix the dressing to your skin, placing the tape a few centimeters away from the actual wound, says Sayed. Many adhesive tapes and bandages are irritating, especially if you must apply them daily. “A lot of patients like a type of tape called Hypafix,” he says. “It’s a cloth tape that’s a bit more flexible and breathable and gentle than a lot of other medical tapes.”
6. Keep an eye out for possible signs of infection. Something that makes HS confusing is that while it’s not an infection, it is marked by pus, which is commonly known as a sign of infection. “One of the things with these chronic HS wounds is that a lot of people fear that they’re going to get infected, and it’s often misdiagnosed as infection,” says Sayed. Infections in HS wounds are not as common as people think, but as with any wound, it’s important to watch for danger signs so that you can catch and treat infection early if it does occur.
Seek medical attention if you notice skin redness that starts spreading beyond the original lesions or if you have fevers or chills or other signs of infection throughout your body. “If it looks like it’s beyond a typical flare, it’s worth talking to your doctor,” says Sayed.
7. Tailor your strategies based on where the wound is located. Wounds on certain areas, like the buttocks, can be hard to reach unless you have help, says Sayed. A large pad held in place by tighter underwear could be an easier solution than using multiple bandages on individual spots. If you have a flare under your breasts, consider avoiding bras that will rub and create friction.
“Sometimes it’s a matter of using a soft bandage underneath an elastic bra strap that will hold in place,” says Sayed.
8. Ask for more help if things aren’t healing. Good wound care is helpful, but it’s not always enough. Sometimes HS inflammation causes wounds that break open and leave behind a hole that just seems not to heal, says Kirby. “That’s really a sign that the HS inflammation, the power of the immune system, is not being adequately controlled,” she says. “And you could do everything right. You could use every correct soap to wash the wound and every correct dressing to put on there, but it’s not because of what you’re doing on the surface — it’s because of the immune system that this wound isn’t healing.”
When a wound is healing, it will fill in from the bottom first, and you will start to see a new film of skin stretching over the top, Kirby says. If the moist, shiny center of the wound is getting smaller, that’s good news. However, if the wound is staying open, opens back up after filling in for a while, starts to drain pus, and has a cycle of pain, redness, and drainage, it’s time to seek help. Reach out to your dermatologist for more help to get the disease under control.
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