I. Introduction

HS is a chronic skin disease that causes painful boils and tunnels that can drain a lot of fluid from the body called exudate. The boils and tunnels can also sometimes break down and appear as open wounds in the skin that take a long time to heal. Due to these wounds, many people with HS have trouble with everyday activities, such as sitting down or walking.

While treating this condition and the associated wounds can often be difficult, people with HS should stay informed about their condition and work alongside their healthcare provider to develop a proper treatment plan. This chapter provides information about the basics of caring for HS-related drainage and wounds.

II. Hygiene and Antiperspirant

HS is not a result of poor hygiene. However, once HS is already active, maintaining basic hygiene of problem areas is important in order to help reduce infections and flares.

Having some bacteria on the body is normal, but too much bacteria (or maybe too many of certain types of bacteria) may lead to increased pain and odor and may also cause inflammation that slows down the healing process. Gentle application of saline or clean water onto the wound is a great first step that can help to slow down bacterial growth.

Antibacterial washes are often used by healthcare providers to help prevent the wound from getting infected or irritated. Diluted bleach baths and over the counter washes containing antiseptic ingredients, like benzoyl peroxide or chlorhexidine, are other common options. Lastly, prescription creams containing antibiotics like clindamycin can be used alongside the washes to help maintain proper wound care. Please see Chapter 16 for more information on topical medications and washes.

Since the underarms are commonly affected by HS, choosing a proper deodorant is of particular importance for people with HS. There is no specific deodorant that is best for HS. When choosing products, it is useful to check if they contain harsh chemicals like aluminum or fragrance because these ingredients can aggravate the skin and make it more difficult to manage wounds. However, there is no specific recommendation regarding the type of deodorant delivery method. Stick, spray, wipe, or gel — use the product that is most comfortable for you. Though keep in mind that it is important to avoid applying these products directly to open wounds.

III. Shaving and Hair Removal

The blockage of hair follicles plays a role in the development of HS. Proper choice of hair removal methods is important because certain methods can aggravate your HS while other techniques can help. Waxing and shaving are common and inexpensive methods of hair removal. However, these practices are discouraged for people with HS because they may aggravate the condition. Remember to use caution if shaving or waxing, and try to avoid shaving during a flare-up.

On the other hand, laser hair removal can remove hair for good and often improves HS symptoms. Laser hair removal uses high intensity light to selectively destroy hair follicles, and therefore addresses a root cause of the disease. This option is more expensive upfront, and may irritate the skin in advanced disease stages. Benefits of laser hair removal include: providing the longest lasting effects, improving quality of life, and preventing future development of HS boils and tunnels, and therefore wounds. You can also ask your healthcare provider to submit a prior authorization request to your insurance for laser hair removal for HS to see if insurance coverage may be possible.

IV. Clothing

Information on clothing recommendations can be found in Chapter 14.

V. Dressings

Choosing wound dressings is best done together with your healthcare provider. If wounds are severe, it is best to consult a wound care expert. There is no single dressing that is perfect for all HS lesions, and your lesion and wound care needs may change over time. However, some helpful suggestions and considerations are discussed here.

HS boils, tunnels, and wounds are often painful, have a lot of drainage, and are associated with a foul odor. Choice of dressings should be made with these factors in mind:

1. Colonization: All HS lesions have some bacteria present and it is important to keep those bacteria in balance.
2. Odor: Is there odor?
3. Pain: Is the lesion painful?
4. Exudate: How much exudate (drainage) is expressed?

The authors of this chapter like the acronym COPE (colonization, odor, pain, exudate) to help remind us of these four important considerations for wound care choices. You can discuss the following with your healthcare provider. For colonization, antimicrobial dressings that contain materials like silver, honey, copper, or dialkylcarbamoyl chloride (DACC) are sometimes used to decrease bacteria on the wound. By using materials that help prevent the buildup of bacteria, there is usually less pain, odor, and drainage from the wound. For wounds with odor, dressings containing silver and salt may help decrease the smell. For pain, dressings made of hydrated gels can soothe and cool the skin, and non-adherent dressings can protect the wound from trauma. Lastly, foam dressings, abdominal pads, and dressings made of absorbent materials like calcium alginate or gelling fibers can be used to manage wounds with exudate.

While many dressings are expensive and difficult to obtain, there are still affordable and accessible options. Most insurances will cover some wound care products and it is important to discuss with your wound care expert what can be ordered for you. Fortunately, many household items and products at convenience stores can also function as dressings for HS wounds. Gauze, menstrual pads, and abdominal pads are commonly sold at most local pharmacies. These products can be adjusted to appropriately fit the contours of the body. Additionally, using cloth tape that is easy on the skin is helpful.

For more advanced wounds, higher quality dressings are strongly recommended. Remember to take note of which dressings work and which do not work for your wounds so you know the best ones to order.

Here is a list of common dressings used for HS: