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Bandages and Dressings for Hidradenitis Suppuritiva
Hidradenitis occurs when a plug of dead skin in a glandular duct that drains into hair follicles on opposite skin surfaces, such as the armpits, under the breasts, and in the groin, initiates an infection process as bacteria multiply in the clogged gland, creating a scab. boil. A blocked gland or boil tears into the deep layers of the skin; adjacent glands are involved; and abscesses occur. Subsequently, several drainage areas or holes appear on the surface of the skin, and the entire hair-bearing area can become inflamed. We call this process Hidradenitis Suppuritiva (HS).
As I described, my first treatment option for this process is to surgically remove the damaged skin and close 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, professional or personal reasons. In the early stages of the disease, timing the situation with topical treatment is appropriate and can provide significant relief.
The Hurley stages diseases are as follows:
- A single or multiple isolated abscess formation without scars or sinuses. (Some small spots with rare inflammation; may be confused with acne.)
- Recurrent abscesses, single or multiple widely separated lesions with sinus tract formation. (Frequent inflammation limits movement and may require minor surgery, such as incision and drainage.)
- Diffuse or extensive involvement in a regional area with multiple interconnected sinus tracts and abscesses. (Inflammation of sites to the size of golf balls or sometimes baseballs; scarring occurs, including subcutaneous routes of infection. Obviously, patients may not function at this stage.)
We now know that in hidradenitis there is an inflammatory process before there are signs of infection such as an abscess, and I call this pre-I stage. At this stage, the skin is intact, with redness, tenderness, heat and burning pains immediately preceding it. an abscess appears. In this early stage, there is no drainage, and the raised swelling may form a nodule, which 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 applicable to these temporary measures due to the degree and depth of skin damage, but these measures can delay disease progression when used in stage I.
Determining the stage of the disease and its appropriate treatment complicates the tendency of the disease to go through silent and active phases. A person with HS administers medication, swallows pills, or changes their diet in some way while the process is going silent, and then mistakenly attributes the silence to the medication, pill, etc. The treatment described here has been robust. were investigated by many groups in a variety of wounds, including HS. They work every day in assisted living facilities and nursing homes across the country.
Topical treatments can be divided into types of dressings and medications that are applied directly to the wound or infused into the dressing.
A dressing is something, such as gauze, that is applied directly to a wound to promote healing, stop bleeding, absorb wound drainage, remove dead surface tissue, prevent medication applied to the wound surface from evaporating or falling off, and protect against or treat infection. In the Middle Ages, they were mainly used to prevent others from seeing their wounds. The historical belief that a wound should be kept dry in order to heal faster without infection was dispelled in the 1960s when research showed that cells on the wound surface died when allowed to dry out, thus prolonging the time needed for healing. Over the past 20-30 years, a large number of different types of bandages have been introduced with different properties or functions.
The TYPES OF BINDING can be grouped as:
are made from seaweed alginate and expand as they change from a gauze-like consistency to a gel while absorbing wound drainage
–WITH CONTACT LAYERS
is made of shallow or non-adherent material that allows drainage to pass through
is made of a material that absorbs drainage and actually draws fluid out of wounds
prevent leakage from the wound and keep the wound surface moist while preventing external moisture from entering the wound. They look like thin pieces of flexible plastic that come in different thicknesses and shapes and stick directly to the skin around the wound. The most commonly used brand is Duoderm.
— TRANSPARENT bandages
are waterproof, keeping external moisture and bacteria out of the wound while keeping the wound moist and easy to assess because you can see through them. The most used brand is Tagaderm.
— MESALT DIPPERING
is impregnated with sodium chloride. They clean wounds slightly by moisturizing devitalized tissue and are also used for moderately draining wounds, especially tunneled or cavitated wounds.
Once you have selected a bandage, the next choice is whether or not to apply medication to the wound and under the bandage, or to infuse the bandage. Manufacturer’s medicated bandages can be very expensive. In this case, you can save a lot of money by applying the medicine to the bandage, rubbing it over the surface of the wound and taping the bandage in place. Unfortunately, this is not possible with silver.
The AVAILABLE MEDICINES includes:
is mostly water in a gel base and is applied to dry wounds to keep them moist and prevent the wounds from drying out
A double-blind study conducted in 1983 found that the topical antibiotic clindamycin was better than placebo in reducing hidradenitis abscesses, inflamed nodules, and pustules during the first month of treatment, and that there was less of a difference between the two 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 that complications are less likely to occur after surgery.
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 painful nodule pain in all patients with hidradenitis suppurativa. The drug cannot be used on areas that have lost the integrity of the skin, as it can be absorbed into the bloodstream and cause a blood disorder called methemoglobinemia (resorcinol poisoning). Drainage is a sign of loss of skin integrity and therefore precludes the use of resorcinol.
References and formulas for honey-based wound dressings can be found throughout the medical writings of ancient Egypt, Greece, Rome, India, and China. Honey was used as a first-line treatment until the mid-1900s, when synthetic dressings and antiseptics grew in popularity. Several studies dating back to 2004 show honey’s antimicrobial, anti-inflammatory and wound-healing properties. More recent studies have shown that adding honey to topical antibiotics improves their effectiveness. This is not your usual cooking or table honey that you put on pancakes. Medihoney and manuka honey are the main wound honeys. They are bitter and not suitable for consumption as food.
- Alginate dressings impregnated with silver and impregnated with honey
- Alginate impregnated with Medihoney
CHOICE OF CLOTHES
Before using these medications or dressings, your doctor must examine you and monitor your ongoing care, including the frequency of dressing changes and bath soaks, to avoid sensitivity or allergic reactions that may occur immediately or after multiple uses of the primary solution. tolerable product. Even the glue in a bandage or tape can be problematic. Obviously, if you are allergic to bee stings or honey, medihoney is not a good choice.
If you have stage I, resorcinol or medihoney under a clear dressing are good choices as they reduce inflammation while allowing for direct observation of the area of disease progression.
If you are stage I and have visible abscess infections, but clindamycin ointment and/or a transparent dressing is not a good choice. This should treat the infection while allowing you to observe the area directly. The ointment cannot be used for a long time because you develop resistant bacteria.
If you start using drainage, alginate or foam pads are better options for suctioning that drainage. Foam is better when the wounds are deep, as foam is thicker than alginate, which allows more wound sealing with less dressing. Both can be infused with either silver or medihoney to fight infection while collecting drainage. They come in 6×6 cm sizes. Impregnated forms are quite expensive, while medihoney tubes can be purchased on Amazon for $15 per tube and transferred to cheaper non-impregnated forms before application.
Once the disease process subsides, you can switch from mesa to dressings, and if there are open areas without drainage, hydrocolloid dressings are very good options. After surgical removal of hidradenitis, hydrocolloid dressings applied to untreated areas have been shown to reduce discomfort, allow faster mobilization, stay drier longer, and reduce nursing time compared to standard gauze dressings. One of my patients had a raw spot on each buttock after surgery, the edges of which would stick together when sleeping and tear open when sitting or walking. Therefore, the regions could not heal. Applying duoderm to each spot kept them from sticking together at night and they healed.
KEEPING BINDINGS IN PLACE
Taping dressings in place can be problematic if the drain has an odor or a large volume due to frequent dressing changes, removing the tape each time, rubbing the surrounding skin. These are 2 good ways to keep your bandages in place.
— tubular elastic netting
To keep the bandages in the groin or butt, you can create shorts out of tubular elastics.
The outer white parts of the Montgomery straps stick to the skin on both sides of the wound and the straps are threaded between the holes to keep the dressing on the wound/wound. To change the binding, you untie and tie the laces. This way you don’t have to tear the tape off your skin. This is especially good for wounds that drain a lot of fluid. You can put alginate there and hold it in place with ribbons. Alginate absorbs drainage like a sponge. You can even change the bandage 3 or 4 times a day if necessary.
You can do this yourself by using a 3 inch wide strip of medical tape and folding the sticky side along one edge to itself. Punch holes in the double thickness of the tape to thread the ribbons through and you’ve made your montgomery strap.
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