The dos and don’ts of proper HS wound care.
Real talk: Hidradenitis suppurativa (HS)—an inflammatory skin condition characterized by painful cysts and bumps—is no fun. The breakouts can be terribly painful, can rupture and leak, and if you don’t care for them properly, can scar and lead to infection. That’s why it’s critical for patients to know how to treat HS wounds effectively, so you can minimize pain, help them heal fast, and keep them from getting worse. Here are a derm’s tips for caring for hidradenitis suppurativa wounds the right way.
Stop! Don’t Pick or Pop
“Whatever you do, do not squeeze, do not pop—it will just increase the inflammation and slow down the healing process,” says Hirshel Kahn, MD, a dermatologist at The Mount Sinai Hospital. Sure, it’s tempting, but contrary to what some believe (just like these hidradenitis suppurativa myths), opening or squeezing wounds to clear out the material will not speed up the healing process. In fact, squeezing the HS cyst will often lead it to rupture deeper down, says Dr. Kahn.
Heal Wounds Fast: Sanitize and Sterilize
Proper hygiene can speed up the wound-healing process and help reduce pain, inflammation, and infection. Keep skin clean, cool, and dry, and minimize bacteria on wounds with these strategies:
1. Use a mild, gentle cleanser. When bathing, wash gently with an antibacterial or antiseptic non-soap cleanser to help minimize germs. Avoid using a washcloth, brush, or anything that’s going to irritate the skin’s surface, says Dr. Kahn.
2. Apply warm water compresses. For acute HS flare-ups, run a clean washcloth under hot water and place it gently on the affected area for about 10 minutes. Warm water compresses can help decrease inflammation and bring pus to the surface, says Dr. Kahn.
3. Try a diluted bleach bath to kill bacteria. If bacteria tend to colonize on your skin, your dermatologist may recommend that you take five- or 10-minute diluted bleach baths (full bath mixed with ½ cup of bleach) at home. Bleach is antibacterial, so it helps treat bacteria within the lesions and on the skin’s surface that may settle into the area and cause it to become more inflamed, says Dr. Kahn. When drying off, gently blot the affected area with a smooth, soft towel.
4. Apply antibiotic cream and dress the wound. After you’re clean and dry, apply a thin film of antibiotic cream to the affected area and wrap with a non-stick dressing (so it doesn’t disrupt the healing process when removed). The type of non-stick dressing you choose depends on the location, severity, type, and amount of fluid coming from the wound. For surface wounds, plain absorptive dressings can be used, but for deeper wounds the dressing needs to be thick and absorbent enough to fill the affected area and absorb all the fluid. It’s also important that the dressing is applied properly so it doesn’t rub against the skin and irritate the wound.
Take OTC Anti-Inflammatories for Pain
“Pain relief is very important, because that is one of the most bothersome aspects of this disease,” says Dr. Kahn. For pain relief, you can take over-the-counter anti-inflammatory medication, like ibuprofen, or stronger doctor-prescribed anti-inflammatories if needed. “Taking ibuprofen three to four times a day when these [HS wounds] are very flared up is very important—it’s part of the whole treatment process for this condition,” says Dr. Kahn.
Get Help From Your Dermatologist
As important as it is to know how to take care of your HS wounds yourself, you should keep your doctor in the loop. “If patients are having a flare up they should certainly call their doctor and be seen. Trying to take care of it at home without having additional help is not going to clear it up very fast.” It may take a week or two for a hidradenitis suppurativa wound to heal, and often times may only do so with the help of treatment form an oral antibiotic or shot of cortisone into the area, says Dr. Kahn.
Treating an HS wound incorrectly could lead to more infection, or cause underlying cellulitis, which a deeper infection of the skin and could lead to permanent scarring.
Dr. Kahn is a board-certified dermatologist and assistant clinical professor at Mount Sinai Hospital in New York City.
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So whatever you do, do not squeeze,
do not pop, that will just
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increase the inflammation and
slow down the healing process.
00:00:12,485 --> 00:00:17,927
00:00:17,927 --> 00:00:25,380
A wound of somebody with hidradenitis
suppurtiva often looks red, inflamed.
00:00:25,380 --> 00:00:27,320
It's extremely tender.
00:00:27,320 --> 00:00:31,150
Sometimes there is some passing
materials coming out and
00:00:31,150 --> 00:00:35,800
there is often scarring around
it from previous episodes.
00:00:35,800 --> 00:00:40,800
Patients often think that if they try and
open these wounds or
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pop them to clear up that material,
that'll speed up the healing process.
00:00:45,830 --> 00:00:49,529
But doing that will often
cause more inflammation and
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squeezing a cyst will often
lead to rupture deeper down.
00:00:54,600 --> 00:00:57,640
The first thing is to
keep your skin clean.
00:00:57,640 --> 00:00:59,760
And so here's what I tell people.
00:00:59,760 --> 00:01:03,020
Wash with a mild gentle soap.
00:01:03,020 --> 00:01:08,580
Do not use a wash cloth or anything
that's gonna irritate the skin surface.
00:01:08,580 --> 00:01:14,050
Someone who has an acute flare up
should apply warm water compresses for
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ten minutes to the infected area,
prior to getting into the bath tub.
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Warm water compresses
are often helpful to decrease
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the inflammation and
bring passing material to the surface.
00:01:29,610 --> 00:01:34,440
Thereafter they should get into
a warm water bath with half
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a cup of bleach and spend at least
five to ten minutes in the bath.
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Bleach is antibacterial, so
it's helping to treat both bacteria
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within the lesions and also other
bacteria that live on the skin's surface,
00:01:50,290 --> 00:01:55,030
that may settle into the area and
cause it to become more inflamed.
00:01:55,030 --> 00:01:57,231
When they get out the bath,
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they should gently dry their effected
area with a smooth, soft towel and
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then apply a thin film of an antibiotic
cream with a non-stick dressing.
00:02:09,013 --> 00:02:13,149
Anything that may stick to the wound will
disrupt the healing process when you
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00:02:13,793 --> 00:02:15,580
It may take a weak or two for
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a hidradenitis suppurtiva
wound to really heal up.
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And often times it'll only
heal up with the help of
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treatment with an oral antibiotic as well.
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Or even with a shot of
cortisone into the area.
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Pain relief is very important,
00:02:32,360 --> 00:02:37,220
because that is one of the most
bothersome aspects of this disease.
00:02:37,220 --> 00:02:41,495
It's very important to take
anti-inflammatories, whether it be
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non-steroidal anti-inflammatories, or
really stronger anti-inflammatories.
00:02:47,070 --> 00:02:51,010
But certainly taking ibuprofen three or
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four times a day when
these are very flared up,
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is very important as part of the whole
treatment process for this condition.
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If patients are having a flare-up,
00:03:00,220 --> 00:03:03,490
they should certainly call
their doctor and be seen.
00:03:03,490 --> 00:03:08,171
Trying to take care of it at
home without having additional
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help is probably not gonna
clear it up very fast.
00:03:12,096 --> 00:03:17,616
Not treating a hidradenitis suppurtiva
wound properly will potentially lead
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to more infection, potentially
could cause underlying cellulitis,
00:03:22,635 --> 00:03:25,998
which is really a deeper
infection of the skin.
00:03:25,998 --> 00:03:27,809
And could lead to permanent scarring.
00:03:27,809 --> 00:03:28,961
Hidradenitis suppurativa. American Academy of Dermatologists Association. (Accessed on January 19, 2018 at https://www.aad.org/public/diseases/painful-skin-joints/hidradenitis-suppurativa#treatment)