Author Katherine Scherling MS, ARNP, CWCN-AP is an advanced practice provider with over 10 years of wound care experience who cares about HS patients and their skin care.
Forward from the author: It’s important to understand that the management of HS requires a multidisciplinary healthcare team. These recommendations should be considered a guide to symptom management, but disease control and treatment should be discussed with your medical provider.
Hidradenitis suppurativa, commonly known as “HS”, is a chronic inflammatory skin condition associated with painful swollen lesions under and/or above the skin that often evolve into draining wounds that may become ulcerated. For patients, the care and management of these wounds is often time consuming, expensive, and isolating. In my experience as a wound care provider, knowing what and where to buy wound care supplies is also an overwhelming and frustrating task for patients. Below are basic guidelines to help HS patients make economical, effective wound care decisions. The products discussed are readily available through online retailers, and local pharmacies, in addition many insurance companies cover wound care supplies which may be discussed with your healthcare provider.
The basic tenets of skin care can be applied to HS wound management:
strive for balance
be gentle
keep it simple
be consistent
Let’s break this down to understand how these recommendations related to HS wound management:
STRIVE FOR BALANCE
Moisture balance is key to good skin health – not too wet, not too dry. Dressings that wick drainage away and allow the skin to breath are ideal. Avoid dressings that hold or trap moisture against the skin, such as hydrocolloids, also called blister band aids – these dressings have a time and place, but not typically for HS wounds. Dressings that are made of wicking material such as abdominal pads (also called ABD pads), or gelling technology often used in feminine hygiene pads, are effective and affordable – that’s right, feminine hygiene pads can be use by men and woman for wound care and are designed to collect large amounts of drainage. Look for products that are hypoallergenic and made from cotton. There are also reusable hygiene pads made from flannel which is a fabric that is absorptive, gentle, and breathable.
BE GENTLE
Dressings which are adhesive (i.e. stick, to the skin) are often expensive and can cause trauma to the skin upon removal. Sensitive skin, or chronically inflamed skin such HS skin, is more likely to develop irritation from adhesives. My general recommendation is to avoid adhesive dressings and find alternative forms of securement.
Such non-adhesive forms of securement include:
Mesh Underwear sometimes referred to as postpartum or post-operative underwear is typically made of polyester + spandex material that is stretchy, light, and breathable. ABD or hygiene pads can be held in place with the mesh underwear and allow for easy exchange.
HidraWear is a proprietary brand designed by an HS patient that offers excellent dressing securement garments for underarm and groin wounds. They also offer hypoallergenic, high absorbency dressings designed to work with the garment.
Tubular elastic netting sometimes referred to as burn or wound netting is highly elastic and able to conform to body contours and nicely secures the wound dressing. This is best for HS on thighs, legs, arms, or neck. Make sure to reference a body site sizing chart before ordering.
If you need to secure your dressings, consider the following:
Silicone based tape is readily available online or at the pharmacy and is designed for sensitive skin and provides fairly good adhesion, however it’s typically more expensive than other forms of tape. Do not use silicone “scar sheets,” these are not designed for dressing securement.
Non-woven breathable retention tape is the most common type of tape for wound dressing securement. The benefits are that it’s affordable, well conforming, breathable, and an effective adhesive, however, it’s more likely to cause skin irritation.
KEEP IT SIMPLE
More expensive doesn’t always mean better. In the wound care world, dressings that have more than one component are called “composite” dressings and are typically adhesive in some regard. As we discussed, non-adhesive dressings such as ABD pads are typically preferred in cases of HS when issues of drainage, moist skin folds, odor, or bathroom needs necessitate frequent dressing changes. Composite dressings are typically limited by size, and poorly designed for large wounds or areas of inflammation. Composite dressings may be appropriate for smaller areas such as behind the neck or single lesions particularly under the breast.
Such composite dressings may include:
Island dressing also known as a bordered gauze dressing comes in a variety of sizes. It is made of a non-adhesive absorbent pad with a border of non-woven retention tape (see above for description) so you do not need to add additional adhesive. It's conforming, low profile, and comparatively affordable. The disadvantages are that it does not hold much drainage and may require frequent dressing changes.
Silicone bordered foam dressing is composed of a silicone adhesive border and foam absorbing center (the silicone layer often covers the foam center and so the adhesive will also be in contact with the wound or inflamed tissue). Foam is more absorbent than bordered gauze, but typically more expensive. They provide some additional padding and stability and thus are often comfortable under the breast or smaller wounds under the arm or abdomen. A non-adhesive contact layer (such an oil emulsion gauze) can be placed first against the wound and then covered with foam dressing to reduce adhesive material in contact with the wound. They can be found in tan color and thus may be preferred for visible areas such as the back of the neck.
BE CONSISTENT
This is a principle I emphasize with all my wound care and HS patients. Chronic skin issues are frustrating, and it’s natural to want to see improvement right way, however, changing your treatment plan too often can confuse the situation.
Keep the product list short. It’s hard to know what is or is not working if there are too many products being used.
Don’t make too many changes at once. Changing too many variables can make it hard to know what improved or worsened the situation. Do your best to be aware of the products you’re using on your skin, this can help you and your provider determine potential sensitivities and work toward best recommendations.
HS is a challenging systemic skin condition. There are no “right” answers when it comes to dressing selection. As a wound care provider my goal is to partner with patients to find the “right” solutions for them. Wound dressings are just a part of the HS treatment needs, that’s why it’s important for HS patients to be connected with a knowledgeable dermatologist to guide the medical, and potential surgical, management of this condition. Skin cleansers, topical creams and ointments, and post-surgical wound care are additional topics that should be discussed specifically with your medical provider.
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Content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay seeking treatment because of something you have read on this website.