Hidradenitis Suppurativa: wound care and management

August 12, 2024August 26, 2024 Danielle Norton

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition. Disease severity is classified and assessed by clinicians using the Hurley Staging system from I- III. This ranges from a solitary nodule like in Hurley stage I to the deeprooted nodules, abscesses, skin tunnels or fibrotic scar tissue found in Hurley stage III. This condition primarily affects intertriginous areas such as axillary, groin, perianal, perineal and inframammary regions, with women affected more than men. The age of onset is around puberty.

According to the British Association of Dermatologists (2018) guidelines on HS, initial management involves providing dressings for pus producing lesions. However, there are no guidelines for HS wound management. The impact of this condition on patient’s quality of life makes even the simplest of tasks much more challenging. This reiterates what research has stated about the negative psychological effect on a patient’s life with HS. Wound management should be tailored to each patient individually. As with HS there is no such thing as “one size fits all”. Every opportunity should be taken in the clinical setting to discuss wound care options. My clinical experience has given me an indepth insight into living with the condition and the impact it has on a person and their family such as psychosocial and financial burden. An example of the financial impact on one patient was devastating as she missed working days due to her HS flares in axilla. This affected her driving to work, resulting in financial loss. The dressings she was using would not stay in place while driving the manual car. An opportunity arose to change her car to an automatic and this had a positive impact for her as it meant the dressings stayed in place on her work commute and resulted in less time off work.

Despite the improved availability of dressings in HS wound management, patients can still find choosing the right dressing for them confusing. Often wounds can be at different stages of flaring and not all dressing carry out the same function. Wounds with heavy exudate require more absorbent dressing while less absorbent dressings can be used with less exudate.

Nurses, pharmacists and doctors play a vital role in discussing wound care options available to patients on both the GMS (medical card scheme) or PCRS (primary care reimbursement scheme). The aim of wound care for HS patients is to improve quality of life, minimise the pain, absorb the exudate from the wound, reduce odour and reduce staining on clothing. They should also be comfortable to wear.

Persistent pus like discharge from wounds can become malodorous. This odour can be a major source of embarrassment in HS especially at dressing changes. Patients report that spraying deodorant directly on to open wound areas can irritate and sting the affected areas. Some patients describe applying dressings on their wounds in order to spray deodorant to the axilla to mask the odour of exudate from wounds.

HS commonly occurs in areas of skin-to-skin contact leading to skin friction. Minimizing skin trauma is vital in HS patients. It is important to discuss clothing modification such as avoiding tight fitting clothing instead wear loose fitting under wear or wear wireless bras with wide straps. Patients should be advised not to scrub aggressively or use harsh skin products. Instead use a nonfragranced gentle wash.

Patients should be made aware that some areas affected by HS may have chronic drainage from their wounds. This can lead to problems for surrounding skin. Peri-wound skin can be an issue for patients as mismanagement of exudate can result in maceration and irritation of the skin surrounding the wound. Repeated dressing changes during the day can result in skin trauma as adhesive dressings sticking to the skin can cause adhesive related skin injury and limit the patient in dressing choices. Patients should be informed before reapplying any dressings the area should be clean and dry.

Often there are indicators that will occur hours prior to appearance of a lesion, these include redness, burning, pruritus or stinging in an area a lesion may be flaring. Patients usually present afebrile and well despite exudate. Therefore, it is important to inform patients that not all exudate is a sign of infection but to be mindful of the signs and symptoms to watch out for and seek medical attention if required. Some hydrofiber dressings contain anti-microbial properties that can help if infection is present. These may need a secondary dressing to keep them in place.

Unfortunately flares in HS can be unpredictable. Over the counter dressings can be expensive. Patients often resort to using cheaper alternatives such as hygiene products, kitchen towel, breast pads or cotton pads if leakage occurs and no dressings are available. Inform patients that these may dry, stick to the wound, and cause pain on removal. Advise patients that wetting the dressing before removal or using adhesive remover sprays can minimise the pain.

Thankfully, patients with a GMS or PCRS have better access to a wide selection of dressings. Some dressings available on PCRS include Polymen, aquacel, adaptic and wound pads. Ensure the dressings prescribed do not need an extra secondary dressing to secure them in place. If a second dressing is required, advise patient how to use them. This list of dressings can be found on the on PCRS website.

A welcomed advancement in wound management of HS is the introduction of Hidrawear. This is available on GMS and Private prescription. This HS specific wound dressing system uses underwear style garments to hold dressings in areas that would otherwise be difficult to secure, such as axilla or groin.

My knowledge of dressings is limited to my clinical experience. I have not received any financial benefits from wound dressing suppliers.