Hidradenitis occurs when a plug of dead skin in a gland duct that empties into a hair follicle in opposing skin surface areas such as the armpits, under the breasts, and in the groin initiates an infectious process as bacteria they multiply within the clogged gland creating a skin boil. The clogged glans or furuncle breaks into the deep layers of the skin; adjacent acorns become involved; and abscesses form. Subsequently, multiple sinuses or holes appear on the surface of the skin and the entire area where the hair is located can become inflamed. We call this process Hidradenitis Suppuriva (HS).
As I have described, my first treatment option for this process is surgical removal of the affected skin and closure of the resulting wound with a flap of adjacent normal skin. However, this aggressive surgery is not always the best short-term option due to insurance, financial, employment, or personal reasons. For the early stages of the disease, topical treatments are appropriate and can provide significant relief.
Tea Internships at Hurley of the disease are as follows:
- Formation of solitary or multiple isolated abscesses without scars or sinus tracts. (Some minor sites with rare inflammation; may be confused with acne.)
- Recurrent abscesses, single or multiple widely separated lesions, with sinus tract formation. (Frequent swelling restricts movement and may require minor surgery such as incision and drainage.)
- Diffuse or wide involvement in a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites the size of golf balls or sometimes baseballs; scars develop, including subcutaneous tracts of infection. Obviously, patients at this stage may be unable to function.)
We now know that there is an inflammatory process present in hidradenitis before there is any sign of infection, such as an abscess, and I call it pre-stage I. At that stage, the skin is intact with redness, tenderness, warmth, and burning pains just before. an abscess appears. At this early stage there is no drainage and a raised swelling can form a nodule that is very different from an abscess. Some doctors prefer antibiotics and corticosteroid injections into the affected areas to treat early stage 1 disease. Others give higher doses of oral steroids or testosterone antagonists. Stage III is not amenable to these interim measures due to the degree and depth of skin damage, but these measures may slow disease progression when used early in stage I.
The staging of the disease and its proper treatment are complicated by the tendency of the disease to go through resting and active phases. The person suffering from HS applies a drug, takes a pill or changes his diet in some way at a time when the process is about to die down and then mistakenly attributes the quiescence to the drug, the pill, etc. The treatments described here have been intensively studied by numerous groups in a variety of wounds, including HS. They are employed in assisted living facilities and nursing homes across the country every day.
Topical treatments can be divided into types of dressings and medications either applied directly to a wound or impregnated into the dressing.
A bandage is something like gauze applied directly to a wound to promote healing, stop bleeding, absorb drainage from the wound, remove dead tissue from the surface, prevent medications applied to the surface of the wound from evaporate or fall off and protect or treat infection. In medieval times they were applied mainly to prevent others from seeing one’s own wounds. The historical belief that a wound must be kept dry to heal faster without infection was dispelled in the 1960s when studies showed that cells on the wound surface died when allowed to dry, prolonging the time needed for wound healing. healing. A large number of different types of dressings with different properties or functions have been introduced in the last 20 to 30 years.
Tea TYPES OF DRESSINGS can be grouped as follows:
–ALGINATE DRESSINGS
they are made from seaweed alginate and expand as they go from a gauze-like consistency to a gel-like consistency as they absorb drainage from a wound
–CONTACT LAYER DRESSINGS
are made of loose or non-adherent material that allows drainage to pass through the material
–FOAM DRESSINGS
are made of a material that absorbs drainage and actually sucks fluid out of wounds
–HYDROCOLLOID DRESSINGS
prevent leakage from a wound and keep the wound surface moist while preventing outside moisture from reaching the wound. They look like thin pieces of flexible plastic that come in a variety of thicknesses and shapes and stick directly to the skin around a wound. The most common brand used is Duoderm.
–TRANSPARENT FITTINGS
they are waterproof and keep moisture and outside bacteria away from a wound while keeping the wound moist and are easy to assess as you can see through them. The most common brand used is Tagaderm.
–TABLE DRESSINGS
They are impregnated with sodium chloride. They cleanse the wound somewhat by moistening devitalized tissue and are also used for moderately draining wounds, especially those with tunneling or undermining.
Once you have chosen a bandage, the next option is whether or not to apply the medicine to the wound and under the bandage or to impregnate it into the bandage. Medicated dressings from the manufacturer can be very expensive, in which case you can save a lot of money by applying the medication to the dressing, rubbing it into the wound surface, and then putting the dressing in place. Unfortunately, that is not possible with silver.
Tea AVAILABLE MEDICINES include:
–HYDROGEL
are primarily water in a gel base and are applied to dry wounds to keep them moist and prevent them from drying out
–CLINDAMYCIN OINTMENT
In 1983, a double-blind study found that the topical antibiotic clindamycin worked better than placebo in reducing abscesses, inflammatory nodules, and hidradenitis pustules in the first month of treatment with less difference between the 2 groups after 2 and 3 months of treatment. No side effects were recorded and the treatment was easy to administer. Topical clindamycin is best used to prepare patients for surgery, so there is less chance of complications after surgery.
–RESORCINOL
is an antiseptic and disinfectant that is the active ingredient in over-the-counter acne medications such as Clearasil. In a 2010 study, topical treatment with 15% resorcinol reduced the pain of tender nodules in all patients with hidradenitis suppurativa. The drug cannot be used over areas that have lost skin integrity because it can be absorbed into the circulation and cause a blood disease called methemoglobinemia (resorcinol poisoning). Drainage is a sign of loss of skin integrity and therefore precludes the use of resorcinol.
–MEDIHONEY
References and formulas for honey-based wound dressings can be found in the medical writings of ancient Egypt, Greece, Rome, India, and China. Honey was used as a first-line treatment until the mid-20th century, when synthetic dressing materials and antiseptics increased in popularity. Multiple studies dating back to 2004 show antimicrobial, anti-inflammatory, and wound-healing-enhancing properties of honey. More recent studies have shown that adding wound honey to topical antibiotics improves their effectiveness. This is not your usual kitchen or tabletop honey you put on pancakes. Medihoney and manuka honey are the main honeys for wounds. They are bitter and not suitable for consumption as food.
DRESSINGS IMPREGNATED WITH MEDICINES
- Silver-impregnated and honey-impregnated alginate dressings
- Medihoney Impregnated Alginate
DRESS SELECTION
Before using any of these medications or dressings, your personal physician must authorize you and must monitor your ongoing care, including frequency of dressing changes and bathing, to avoid sensitivity or allergic reactions that may occur immediately or after multiple use. applications of an initially fine. tolerated product. Even the adhesive on a bandage or tape can be problematic. Obviously, if you’re allergic to bee stings or honey, honey isn’t a viable option.
If you are before stage I, resorcinol or honey under a transparent dressing is a good option, as it will reduce the swelling and allow you to look directly at the area for disease progression.
If you are in stage I with visible abscess infections but no drainage, clindamycin and/or medihoney ointment under a clear dressing is a good option. This should treat the infection while allowing direct observation of the area. The ointment cannot be used for long periods of time because it will kill off resistant bacteria.
Once you start to have drainage, alginate or foam dressings are better options to absorb this drainage. Foam is best for deep wounds, as foam is thicker than alginate, allowing for more wound padding with less dressing. Either can be obtained with silver or honeydew impregnated to combat infection at the same time the drainage is collected. They come in sizes as large as 6x6cm. The impregnated forms are quite expensive, while tubes of medihoney can be purchased on Amazon for $15 a tube and are applied to the cheaper non-impregnated forms prior to application.
As the disease process subsides, mesalt dressings can be transitioned to, and if there are open areas without drainage, hydrocolloid dressings are a very good option. Hydrocolloid dressings applied to raw areas after surgical removal of hidradenitis have been shown to minimize discomfort, allow faster mobilization, stay dry longer, and reduce nursing time compared to conventional gauze dressings. . One of my patients had a raw area on each buttock after surgery whose edges would stick together when sleeping and tear when sitting or walking. Therefore, the areas could not heal. Applying Duoderm to each blemish prevented them from sticking overnight and healed.
KEEP DRESSINGS IN PLACE
Tape dressings in place can be problematic if the drain has an odor or a large volume, as frequent dressing changes, removing the tape each time, irritate the surrounding skin. These are 2 good options for keeping bandages in place.
–Tubular elastic net dressing
You can create shorts made of tubular elastic to hold bandages on the muzzle or buttocks.
–Montgomery Straps
The outer white portions of the Montgomery straps adhere to the skin on both sides of the wound and the cords are threaded through the holes to keep the dressing on/in the wound. You untie and tie the laces to change the bandage that way you don’t have to keep ripping the tape off your skin. This is especially good for wounds that are draining a lot of fluid. You can put an alginate in there and fasten it with the laces. The alginate will soak up the drainage like a sponge. You can even change the bandage 3 or 4 times a day if you need to.
You can make your own by using 3-inch-wide medical tape and folding the sticky side in on itself along one edge. Punch holes in the double-thickness part of the ribbon to thread the laces through, and you’ve made your very own Montgomery strap.
