Patients with hidradenitis suppurativa (HS) need wound care not only after surgery, to address HS scarring and tunneling from sinus tracts, but they also need ongoing wound care for lesions that might be draining, said Afsaneh Alavi, MD, assistant professor of dermatology at University of Toronto.
There are different aspects of wound healing in HS patients, said Alavi, who presented on wound healing and the HS patient at the March 2017 American Academy of Dermatology meeting in Orlando. The literature is more focused on post-surgical wound healing after an HS patient has had either minor surgery, such as with the laser, or excisional surgery.
"The concept of this type of wound care is similar to care for other post-surgical wounds. You want to promote healing, shortening the time that the patient has the wound. You also want to make sure you have less contracture after surgery," Alavi said.
The other aspect of wound care in HS patients, and one that is generally under-recognized is wound healing for lesions that are draining, according to Alavi. These patients live with draining lesions either because they're on medical therapy or because they are not candidates for surgery.
"I think this is a major challenge for patients with HS because they have this horrible wound in an area like the axilla or groin. And they have wound abscesses. They live with drainage and exudate from these wounds," she said.
Wound healing in this case calls for use of a dressing, but there is no specific dressing for HS patients.
Alavi said the ideal dressing for HS patients has good absorptive capacity, is atraumatic (easy to apply and easy to remove), and is useful for special body sites, like under the arms or the groin. The form of the dressing should be appropriate to use in skin folds.
"And it shouldn't be expensive, because these patients need a daily change, and they are living with this disease," Alavi said.
The dermatologist said the wound-care industry should work at developing a dressing specifically for HS patients, but in the meantime there are products on the market that physicians can use.
Dr. Alavi noted that in treatment of lesional wounds, not every patient with HS needs antiseptic.
"We don't need to use antiseptic routinely for patients with HS. But there are certain cases in which the ulcers or lesions of HS are colonized with bacteria, and that causes a smell, which is another factor that causes social isolation for these patients. Using an antiseptic in those cases helps to improve the condition and should be used for the short term," she said.
For HS patients who have wounds due to surgery to remove scarring and tunnels, more than dressings might be required. Dermatologists and others should consider advanced wound therapy, such as advanced wound dressings for stalled wounds, cell-based therapy, growth factors, or negative pressure wound therapy, to make sure the patient heals as quickly as possible, according to Alavi.
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Disclosures
Alavi disclosed relevant relationships with AbbVie, Galderma Canada, Janssen Pharmaceuticals, Regeneron, Valeant Pharmaceuticals North America, and XOMA (US).