Wound healing and the HS patient

Patients with hidradenitis suppurativa (HS) need wound care not only after surgery, to address HS scarring and tunneling from sinus tracts; they also need ongoing wound care for lesions that might be draining, says Afsaneh Alavi, M.D., M.Sc., F.R.C.P.C., assistant professor of dermatology at University of Toronto, Toronto, Canada.

There are different aspects of wound healing in HS patients, says Dr. Alavi, who presented on wound healing and the HS patient at the March 2017 annual meeting of the American Academy of Dermatology in Orlando, Fla. 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,” Dr. Alavi says.

The other aspect of wound care in HS patients, and one that is generally under-recognized, according to Dr. Alavi, is wound healing for lesions that are draining. 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 says.

Wound healing in this case calls for use of a dressing. But there is no specific dressing for HS patients.

Dr. Alavi says 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,” Dr. Alavi says.

The dermatologist says 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 with these characteristics.

Dr. Alavi also notes 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 says.

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 Dr. Alavi.

Disclosure: Dr. Alavi is an advisor, speaker, educator and researcher for AbbVie; advisor for Galderma Canada; advisor for Janssen Pharmaceuticals; investigator for Regeneron; advisor for Valeant Pharmaceuticals North America; and investigator for XOMA (US).