Dos and Don'ts for Treating HS Wounds at Home

Keep in mind that having HS has absolutely nothing to do with bad hygiene. (The cause of HS is unknown). Which is small comfort to you when wounds, well, smell. “Malodorous drainage is a unique feature of HS,” says Anthony Fernandez, M.D., director of medical and inpatient dermatology at Cleveland Clinic in Ohio. While some people with chronic inflammatory skin disorders can conceal their conditions, any unpleasant-smelling drainage can make it impossible to hide HS from others. He notes that taking meticulous care of wounds helps with healing, prevents infections, and lessens bad odor.

At-home HS treatment plans focus on controlling your symptoms—and may involve doc-prescribed antibacterial creams, pain relievers, antibiotics, and anti-inflammatory medications, plus some alternative therapies (more on those later). “What people do at home really depends on the severity of the wounds they have,” Dr. Fernandez says. No matter how severe your HS is, though, he stresses the importance of regular—and gentle—bathing, and applying a topical antiseptic like over-the-counter Hibiclens (chlorhexidine) or prescription-strength Cleocin (clindamycin) directly to your wounds to decrease the amount of bacteria on your skin, which lowers your chances of infection.

Some people’s skin tends to get overrun with bacteria. If your dermatologist thinks you fit into this category, he or she may recommend you take bleach baths. However, take a bleach bath only if your doctors specifically orders it—and, then, follow instructions to the T, urges Dr. Fernandez. Bleach baths use a minimal amount of bleach because it’s a harsh chemical, and “if you’re not using it the right way, it can do far more harm than good,” he explains. If this is a treatment you’d like to try, be sure to chat with your doctor first.

High-quality wound dressings are a critical part of at-home care because they can make or break your quality of life. Such dressings not only promote healing, but Dr. Fernandez says certain kinds are great at absorbing smelly fluids and keeping your clothes drier—which helps minimize embarrassment. If your insurance company will pony up, pricier dressings like silver impregnated foam ($3.75) and calcium alginate ($1.60), are comfortable, highly effective, and they help decrease pain and control drainage. If insurance won’t foot the bill, keep reading for some alternative dressing materials that are also quite effective.

Dr. Fernandez recommends making alternative wound dressings out of sanitary napkins, adult incontinence underwear, or infant diapers, all made of highly absorbent materials. “These products are made to wick moisture away from an area, so they’ll protect the surrounding healthy skin too,” he says. Flexibility in a dressing is a must, since HS affects areas curves, like under your arm, beneath your breasts, and in the folds of your groin. He recommends gauze too—just not in areas with a lot of drainage, because it can stick to the wound and cause pain and trauma when it’s pulled off.

How you apply your dressings is really mostly about your personal preferences, says Christopher Sayed, M.D., associate professor of dermatology at the University of North Carolina at Chapel Hill. He recommends using a tablespoon of white vinegar in some warm water as a mild, inexpensive antiseptic for your wounds that won’t sting. It’s probably easiest to clean your wounds while you shower, but if you want to do it separately, that’s fine too. Look into a tape called Hypafix ($6.77)—Dr. Sayed says it’s a favorite with HS patients because it breathes and it’s gentler on skin than many medical tapes.

The main goal of using topical creams and ointments on HS wounds is to help decrease the number of bacteria so they can heal faster—and none of these methods do that, Dr. Fernandez says. He’s concerned they could contribute to hair follicle blockage, especially since they all tend to be thick—and tea tree oil is an oil, which can lead to clogging. “Honey dressings are popular right now, but there’s zero evidence that they help HS,” Dr. Sayed says. “It will probably just make a mess and with questionable benefit.”

Though you may have heard it’s helpful to use petroleum jelly on your wounds, Dr. Fernandez says, nope, it’s not true. First of all, if you’re trying to put it on a wound that’s draining, you’re going to get nowhere. Second, the absorbent material in your dressing should be in direct contact with your wound so it can soak up the fluid. And like honey and aloe, petroleum jelly is super thick, so if you get it on the skin around the wound, Dr. Fernandez says it could plug your hair follicles and then aggravate the inflammatory process of your disease.

As you care for your wounds, don’t neglect the rest of your body—or your mind. Since excess skin folds can make your HS wounds worse, try to move more (even daily brisk walking can help) and eat a healthy, anti-inflammatory diet for weight loss. When possible, wear loose-fitting clothing to ease friction and pain. “For some patients, this helps decrease the disease activity,” Dr. Fernandez says. Dr. Sayed adds that smoking is linked to worse disease over time, so do everything in your power to ditch the cigarettes, too. And, don’t despair: HS treatments can improve your symptoms and decrease flares—so, DO have hope.